820013_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

,j�
i ype or visit. Ly1 ompuance inspection v [operation rceview tV Ntrucrure r.vaivation V i ecnnicai Assisiance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: t7 3'D Departure Time: County:, r_ Region: r �
Farm Name:
Gt / ram.
Owner Email:
Owner Name:
Ig
r- i
G
Phone:
Mailing Address:
Physical Address:
Facility Contact: �� T (,(' ; (', d Title: Phone:
Onsite Representative: // Integrator:
Certified Operator: A Certification Number: -
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current Design Current
WIN
Swine Capacity Pop. Wet Poultry Capacity Pop. Gattk Eapacity Pop.
Wean to Finish `�� La er airy Cow
Wean to Feeder
Q Non -La er
Da' Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,ou Ca aei P,,o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qtft-erill
Other
Turkeys
Turkey Poults
Other
Discharges and Stream lmoncts
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 Co No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [—]No
❑ Yes [—]No
❑ Yes [LNo
❑ Yes L2LNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3(,
5. Are there any immediate threats to the integrity of any of the structures observed? [-]Yes [3.No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes allo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? (a -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 [ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes [�JNo ❑ 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 Types)=tm 1[�ac /Q1L5�-c�r?� vi ��SY3 yfrr /tc� Y-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes 0 No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes [allo ❑ NA ❑ NE
❑ Yes [;&No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes (S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [::]Yes allo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes allo
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes O-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: p'Z- jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
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 C3,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
a
Reviewer/Inspector Name:
ReviewerlInspector Signatm
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑, No
❑ Yes L�j No
❑ Yes KNo
any
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 0-,7V 3y__37 IDI/
Date:�8-
21412015

Type of Visit: Cj Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: AZrRoutine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 'i ` i �Otd "(/l Owner Email:
V n
Owner Name: /xf.eG`'L �y`' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
4
Title:
Latitude:
Phone:
Integrator: k4 `!
Certification Number: 2—'(I.f3
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish aj
Current
Pop.
i
Design Current
Wet Poultry Capa.00 city Pop.
Desigu
Cattle Capacity
Da' Cow
Current
Pop.
Wean to Feeder
FLayer
LFarrow
Non -La er
Da' Calf
Feeder to Finish
Design Current
V. P,oultr. Ca a_ ci. P,o
La ers
DairyHeifer
Farrow to Wean
Farrow to Feeder
to Finish
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
ITurkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes B-Nd— ❑ NA ❑ NE
❑ Yes
❑ No
[],#A
❑ NE
[:]Yes
❑ No
[]>-K
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No E31<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [;?No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page J of 3 21412014 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[-]Yes
Eq o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
C <
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^ - R
S
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r' -� �-� ��
30
5. Are there any immediate threats to the integrity of any of the structures observed?
[-]Yes
U21<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�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
[RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F1Qo
❑ 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
[l""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 [�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
in�dow ❑ Evidence of Wind Drift p❑ Application Outside of Approved Area
CAW 12. Crop Type(s): 9 S6y
13. Soil Type(s): -Way i110
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2*No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RjoNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
03"No
❑ NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
[TNo
❑ NA
❑ NE
[:]Yes [ErNo ❑ NA ❑ NE
[-]Yes L*- ❑ NE
NA ❑
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [i 01Qo NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes g�No NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [jlo NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o 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:
❑ Yes ETNo NA NE
❑ Yes [3No
Yes [!10'No
[] Yes [2<o
F]NA [:]NE
NA ❑ NE
[] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes [] No NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes []No ❑ NA 0 NE
34. Does the facility require a follow-up visit by the same agency? Yes [/ No NA NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Iq
�L � �` � �"f 4 •
Reviewer/Inspector Name: `l Phone:
Reviewer/Inspector Signature: Date: 0 T (b
Page 3 of 3 21412014

�.��r sue,
Type of Visit: (DCom fiance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: =utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: tL County: Region:
Farm Name:
[
4. rl
Owner Email:
Owner Name:
f/ ti L V AA_ <
6
Phone:
Mailing Address:
Physical Address:
Facility Contact: F-c' h K % -C (J V t L A1_ffitle: Phone:
Onsite Representative: t Integrator: kl9
Certified Operator: L Certification Number: L( ,S.3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop. -
Wet Pointry
I ILayer
Non -La er
Design
Capacity
I
Current
Pop.
E�]
Cattle
Dairy Cow
Design Current
Capacity Pop.
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,onl
Layers
WDegign
C►_a aci
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
I Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
E
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes NA ❑ NE
❑ Yes ❑ No L`� A ❑ NE
❑ Yes ❑ No [ ❑ NE
❑ Yes
❑ No
[35NA
❑ NE
❑ Yes
[]"To
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
Page 1 of 3
21412014 Continued

Facili Number: - Date of Ins ection: "
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [B"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [0-N"A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes LJ Ko' ❑ 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 [] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6"N/o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes 0"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
UrNo
❑ NA
❑ NE
maintenance or improvement?
No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑
❑ 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): B c_A7
13. Soil Type(s): NU „2�
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
GKo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�N
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[K
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3No
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]
❑ 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
[:)Yes � o
[:]Yes ["No
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?
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
1 t t waste application equipment as required the e Y NA 24. Did the facility fay o calibrate appl2ca on egmp q ed by permit? ❑ es �� ❑ ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L.(Wo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Nc ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ��o❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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 0—No
❑ Yes No
❑ Yes 0<0
❑ Yes 0N
[—]Yes [�No
❑ Yes N
C]Yes ;JNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: 5 q' S
21412014

Type of Visit: 4 'Comntiance Inspection Q Operation Review 0 Structure Evaluation 0 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: Arrival Time: �Departure Time: - r" County: a �„
Farm Name: �d rJ -['il 0.�i �m Owner Email:
Owner Name: W�rrf`�"t Phone:
Mailing Address:
Physical Address:
Region: I
c l-}
Facility Contact: DA(4 l 't W �� S Title: Phone:
Onsite Representative: t t Integrator: Certified Operator: J L( Certification Number: 2K
Back-up Operator: 4 q l
Location of Farm: A'.' z iA J t 1k
t0✓5 E V C'4c�c 41
S 3 Latitude:
Certification Number:
Longitude:
Design
Current Design Current
Design C+urrent
Swine
Capacity
Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish _
p
—
Da' Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
I) . P,ou1t . Ga aci P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ
Other
I
10ther
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 No ❑ NA ❑ NE
[:]Yes
[:]No
'
❑ NE
[:]Yes
[:]No
E 34A
❑ NE
❑ Yes [:]No
[:]Yes [TNo
❑ Yes �To
D4
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili 'Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q-Mr�_E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑-#A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —�'
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees,.severe erosion, seepage, etc.)
j
❑ Yes Ea-Ko­ ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3-75o_—❑
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
r l l`o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q-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
B-N
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
e-N1-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E3,V-o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G e G
13. Soil Type(s): No ok
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
is l"o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3] No
❑ NA
❑ NE
Required Records & Documents
/
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!�'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
To
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�j o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - D N i Date of Inspection: -it) zr _
24'. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E24o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ErNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ETNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
BTo
❑ 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
D<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
Q<
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
To
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E2['1To
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
e No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E5,Mb
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other..comments.
Use drawings of facility to better explain. situations (use additional pages as necessary).
04
3,3
r ~_'S
avlvz)
jo
t rr S
IV SCuC S�vtl sc.�w►lG 361� C,�ti�
e,,--,- F
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: io—q33- 33 3V
Date: b
. A I -
21412014

(eIIgl is
(Type of Visit: UCom liance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 1 County: Region:
Farm Name: t�(LR Owner Email:
Owner Name: NO-0-9 {\ V�N& N'r L' a' Phone:
Mailing Address: �� Lo �� A� �.. �Ivo p'o . N E- k.. Ao r" aK009-
Physical Address:
Facility Contact: Baia-r- ,,L M T_pn,tZ Title:
Phone:
Onsite Representative: 's p�mg— Integrator:
Certified Operator: R ujPQ—T W 0'q'Q _fN
It
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: I Ct 14
Certification Number:
Longitude:
LAO-
Swine
Wean to Finish
Design Current
C.00
apacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
7Da
ttle
' Cow
Design C►arrant
Capacity Pop.
Wean to Feeder
Non -La er
Calf
Feeder to Finish
-{eluap
' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
w10
D . P■oul
Layers
Design
Ca aci-
Eurrent
P■o ,
Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Discharges and 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)
Yes NJ No NA ❑ NE
Yes No
Yes ❑ No
NA NE
NA NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) Yes No NA NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes ® No [] NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Ej Yes No NA [] NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: b a.- j Date of Inspection:
j a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
aNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: :F Lk
S
Spillway?:
Designed Freeboard (in): �� Cq /�'1
/ -C --
}L,R
Observed Freeboard (in):5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1K] 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
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] No
AO
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Drill ❑ Application Outside of Approved Area
12. Crop Type{s}: C['f ASTA l deitt'nuo a-
13. Soil Type(s): rAL usr Li
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
rUW
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes LN No
[:]Yes 5;] No
❑ Yes 5� No
D Yes "] No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: jDate of Inspection: I
E 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
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:
2b. 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?
❑ Yes IVI No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ® No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes fV1 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations'6r'any'othei "commetats.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3 of
Date: le� 1311 -;X
21412011

YA I
type of visit: %e7t.ompuance inspection v operation tceview V arructure r.vaivanon v tecnnicai Assistance
Reason for Visit: i�r Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: E] Arrival Time: QL Departure Time: < < County: S001 Region: PRO
Farm Name: wdofitih s e _ �mf Owner Email:
Owner Name: WOlr?n Fiqfm ll 4 co Phone:
Mailing Address:
Physical Address:New G/OI.�
Facility Contact: ° -J1 [ 110' j' Title: Phone:
Onsite Representative:
Certified Operator: Rude Wdlrf�
I_ _.
Back-up Operator:
Location of Farm:
Latitude:
Integrator: Q_ H—
Certification Number: (q(y5-
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Da' Heifer
Farrow to Wean 3
Design C*urrent
Dry Caw
Farrow to Feeder
Dry P�outtry C+_a act_ P,o
Non -Dairy
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [:]Yes CRNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Number: IDate of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
10 Designed Freeboard (in): .� 1 q _ ! q J& i q �! 9 AJ-P Oil �'��J
Observed Freeboard (in): — � � � a J AS'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [RNo ❑ 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
CR 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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
CR 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
21 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): %jp�`�}j �P/It LG12�1 ¢ ;Sl1lLi� Qllll�rl I�yNk�t�: �!�'n_h'hfr�So>hrgfly. ki�
13. Soil Type(s): 1L!(,N-ke f$l EA/4, N[Y*14 is A)QA majg 2 L� h(a_9 - -
✓ 14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Eg No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
U 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 ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes N No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes ® 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 21412011 Continued

Facili Number: C9 a -
Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check (3 Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
ERNon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: Woo) 9 ,
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
M Application Field ❑ Lagoon/Storage Pond ❑ Other:
0 Yes CR No Q NA ❑ NE
❑ Yes N No 0 NA 0 NE
Yes 'R No NA ❑ NE
[WYes No NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes
® No
NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
E�r No
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? D Yes
® No
NA
❑ NE
Comments (refer to question ##):Explain any YES answers and/or any additional recommendations.oF any
Use drawings of facility to better explain situations (use additional, pages as necessary).
I , Pl Sfu lea kiY� Pra s� ic, cow plaeIawain
q e� cow as`we_., filch sc�,�,yr,,� cart" rva ,
N4-1c. Cof Off- Ott sf an wo I
a' 1, Wa V0(kon 3 rN Co')&r 0A 4100A- a lowly s1 ai dje, cIetau — n ieKfsn`n wod!d b
Lo' Meg Yv0xip— P10'y w of qfI I I1,
Q31 Form has ba��- l,��naenf s(l.� cla7,wt tend *jec+_s � do r`�- is dal 1, S1 dd�
Plroe( f ( f
r� e f
y
RV65f a e�,-1z,a��dfa,hs-�owcrd.becc����ot �o�edra��,'�J
�4d� +ay,Ql *absv� noton toduW Coed,
n
Reviewer/Inspector Name:Q
Reviewer/Inspector Signature:
Phone: 1 3yao (6L 11)
Date:sepf-aa,3011
21412011
Page 3 of 3

(0j I
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Imo) 1
L40
_ OT
%' rs R 5%. %7(�
'F� ili N a1�3 F N �'VA�I� sW1�2 D t
ac ty o. c/ amp, ame a e
Permit ✓ COC OIC NPDES {Rainbreaker
i Q 3
Pop.
Type
Design
Current
Spillway
Design freeboard
Observed freeboard
Sludge Survev Date
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
A mCY ! 11 t f
Calibration Date f
1
Design Flow
jpp
Actual Flow
too
Design Width
300
Actual Width
D�-S
��� ��,..vm(t
Soil Test Date 't !Jdlo
pH Fields
Lime Needed
Lime Applied
Cu-I ✓ Zn-I
Needs P �� t r
Croo Yield ✓ ��b
I .��t'7.
ffi�fflrmzm
1 +inl Wr% 2 1 nol 3
Wettable Acres
WUP
Weekly Freeboard lV
1 in Inspections _-
120 min Insp.
Weather Codes
Transfer Sheets �—
&4
0
-I! ' , - -
moo MM
RM/M=M� �
■i�
©�0
la10 I a+r
Cltdn�,.,, cot, (W *w
], RAIN GAU6
7Dead
box or incinerator
Mortality Records
�1191-�Mff
�,
l
NAmt(lb/100OGal)
. .
MOM
v
Verify PHONE NUMBERS and affiliations
Date last WUP FRO -kilbp
Date last WUP at farm
FRO or Farm Records
i
a 3 9
Lagoon #
Top Dike 50
�$
Stop Pump q&,j
]
Start Pump `N, 3
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware
`.�kq,Ot
S 91-fi h"t(z&, )"
51/4
i.a-
j,9
C#

bChtl0e'-% lbO='X CWM`SM
QSIEE'SI- beeoTSL
Vh1 1 b r7
los
46
Hb Tj
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IOD
Volh(
0q, —0
LIN III ~,IN
Q L Ulvrro
-l" wam

e
Facil�ly�Number 2� _ /,� -.O D
M
f Water Qtrahty
F Soil and Water Conservat�on,i
Type of Visit EYCompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: �.3s Departure Time: .S: i0 County: Region:
Farm Name: 6jQ VV e-N SW ;14�t_ 7F4. y P-L S Owner Email:
Owner Name: war✓GN l�a rk.t �..� C�,.tpgf__ 3 Phone:
Mailing Address:
Physical Address:
`2D
Facility Contact: �c'v�r+�t l,.)i tI aw-. 5 Title: rQ A4-se-y Phone No:
Onsite Representative: Integrator• ^!4�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� O [= ` 0 u Longitude: = ° =1 = u
�. Design Current" —,Design —, Current ,Y Design Curren#"w
Swuie ,# �.,, ,Ca actty Po Mahon Wet�Pobl Ca aci Po ulatton- Cattle } ;.. pacity7Popula 'on
❑ Wean to Finish
19 Wean to Feeder
72 Z r
® Feeder to Finish
p
® Farrow to Wean
117S
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
J Layer
I
I
U Dairy Cow
] Non -Layer
❑ Dairy Calf
ElDairy Heifer
t ❑ Dry Cow
?�
Dry Podltry
❑ Non -Dairy
Non -Layers
❑Beef Feeder
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes L" No ❑ NA ❑ NE
❑ Yes
❑ No
L.-S'NA
[I NE
❑ Yes
❑ No
to
❑ NE
L1 NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
[INE
ro
ElYes
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment ,�,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ;T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S/ Z Z �� r�2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ['No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ETNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes EK,o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑yes l�1vo ❑ NA [I 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 D'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�,
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ L9
Yes 1vo ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ D Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) l (�b►-ni . t�l�cc�.lL _ Sr,,.G,.a��5 Jse..ci
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,3No
L 44.
❑ NA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2 NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[IYes
[; o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3<
❑ NA
❑ NE
`Codiraents (refer to gueshon #) _ Ezplam any YES�ansRers andlor any recommendations�or any oilier"comments.
w -
-Use drawings of facility to bettervexplam situai�ons. (use additional pages as�necessa> ,
o ��Srb, rr3�-�300
Reviewer/Inspector Name , - _ = �� Phon
'P.V �.w
Reviewer/Inspector Signature: Date: Z 0/0
12128104 Continued

Facility Number: $2 — 13 Date of Inspection
Required Records & Documents ,�,
19. Did the facility fail to have Certificate of Coverage & Perm(_i{
Pen -nit readily available? ❑ Yes 'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes 2 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9<o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
El NA
El NE
El Yes
�G-144o
o
❑ NA
❑ NE
❑ Yes
2 o
El NA
El NE
❑ Yes
L"10
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
l_H'No
❑ NA
❑ NE
❑ Yes
B<
❑ NA
❑ NE
❑ Yes
E o
❑ NA
❑ NE
❑ Yes
B<o
ElNA
❑ NE
ElB Yes
o
❑ NA
❑ NE
Add tional tomments and/or Drawings..'
Alb -
Page 3 of 3
12128104

1.
Z Ms P-2-3-2.009-
- ivision of Water Quality
�Faeility Number 8 Z l� 3 Division of Soil and Water Conservation
0 Other Agency
Type of Visit &C�om_pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (51ioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: II f9 -A% Arrival Time: Departure Time: ; 30 County:. '�`�'",/»^ Region: F
Farm Name: /f14 ✓rG.l Su.1: LIJ e- r`+-eS I caner Email:
OwnerName: Waved /�G rlp%. 61.11421muf Phone:
Mailing Address:
Physical Address:
Facility Contact: RD NN, e l,Jf%t! � Title:fir✓ . Phone No:
OnsiteRepresentative: 4,vlVie- It/;//.i �.5 --� Integrator: /W—,g
Certified Operator:
�e vn►ic-
W,'�/iu...S
Op erator Certification Number:
2V /_$7
Back-up Operator:
�9P�r jd
"`f �'�` ""
Back-up Certification Number:
g� r
Location of Farm: Latitude: = o = 1 = u Longitude: = o = 4 = fI
Design
Current Desig31-m-
LC, apacity
Population Wet Poultry Capacity opulaton
JEI Layer
C►attle Capacity
Population
❑ Wean to Finish
❑ Dairy Cow
can to Feeder
❑ Non -Layer
❑ Dairy Calf
2feeder to Finish
53i�
❑ Dairy Heifer
21arrow to Wean
/3_45'
1//7-5 Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ ers ❑ Non -Dairy
El Beef Stocker
❑ Farrow to Finish
❑ Gilts
-L
Non -Layers
❑ona ers
❑ Pullets ❑ Beef Feeder
El Turkeys ElBeef Brood Co
❑ Boars
Other
❑ Other
❑ Turkey Poults
❑ Other Numher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Yes
ElL''f
,.,�
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑<
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[3<A
❑ 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
LJ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E❑
0<
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ffN.
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:
Date of Inspection /ki 9-V' 9'
Waste Collection & Treatment //
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 2 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D<o ❑ NA ❑ NE
Structure0 Structurao Structur4o Structurlo Structured 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 B o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�, /
6. Are there structures on -site which are not properly addressed and/or managed El Yes [3<o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes LJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
9. Does any part of the waste management system other than the waste structures require El Yes Ll' o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop tyPe(s)
13.
Soil type(s) IVoA Ufa Q
14,
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ETNNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Lei No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[YNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L7 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andfor any irecommendatibns or anyrother eomWents. -
Use drawings of facilitv'to better explain situations (use addttional pages as necessary)
Reviewer/inspector Name j ir W phone: o, fy33, a3oc7
. .
Reviewer/Inspector Signature: - Date: To09
I2128104 Continued

y
Facility Number: $ ,2 - /3 Date of Inspection �/ may- 0 9
Required Records & Documents ,,,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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
O No
❑ NA
❑ NE
- 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NEo
❑ NA
[I NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
Lf�J NN-
El NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LfiNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LJ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3 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?
El Yes
,�_.,,//
1" 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
ElO Yes
,
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E3<o
❑ NA
❑ NE
12128104

RUNS Eiyk`e-c( 0//V V/0D09
® Division of Water Quality
Facility Number Sri 0 Division of Soil and Water Conservation
- - 0 Other Agency
Type of Visit WCompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: {Z Z��{��-��� 7 Arrival Time: 9, 3p A� Departure Time: 2 3� �yJ County: 5!L -xo4l _ Region:
Farm Name: ala-YY sii✓L r S Owner Email:
Owner Name: �9tQy�d N�i�1'u'� Phone:
Mailing Address:
Physical Address:
Facility Contact: ONwlf �r<! �s Title: _y Phone No:
Onsite Representative: �ii.r/N�G &1,1V</,-A.4—r Integrator: 17?-'Jl!%9lr f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ e = r ❑ " Longitude: = ° ❑ i =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
❑ Wean to Finish
® Wean to Feeder
Feeder to Finish
O
Farrow to Wean
IZOO
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Pullets
Poults
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 Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Fil
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 Ix No ❑ NA ❑ NE
❑ Yes
EZ No
❑ NA
❑ NE
❑ Yes
q No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[9No
❑ Yes
R1 No
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
12128104 Continued

Facility Number: $'2 —/,3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [Z No ❑ NA ❑ NE
a. If yes, is waste level
into the structural freeboard?
❑ Yes ® No ❑ NA ❑ NE
Structure 1
Structure 2 Structure 3
Structure 4
Structure 5 Structure 6
Identifier: Actq �� _
-0Z Lc �.3lac
es —
Spillway?: NOW
_11114,
Designed Freeboard (in):
Observed Freeboard (in): Z
Z S Z rig
Z 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
[� No
❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[21 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
Wo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
P9 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes
[� No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
GYNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�l No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name j ,e,Ve& Phone: 916?. 5f33. 330-D
Reviewer/Inspector Signature: a..� Date: !2-21-2607
12/28104 Continued

+ • . •
Facility Number: SZ — /3 Date of Inspection /x 2/-d7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ yes o No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes [3 No ❑ NA ❑ NE
the appropiiate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T 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
O No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
it No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�zNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JM No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JUM No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

a
Type of Visit 49 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: �'ZS-� Arrival Time: / ,ZQ Departure Time: ; O County G On! Region:
Farm Name: _ 1&2awt.,j l!Sryw�- Owner Email:
Owner Name: G c.y-a.l d L J a.yVd'..! Phone:
Mailing Address: PO Ba;< Z Z.3 _ _ai-a v c HC. Z 9366
Physical Address:
Facility Contact: o unr I w i 1 t ia"' S Title: i,— • Phone No:
n / IN
Onsite Representative: 11 on�i9I 1_A_�i Wa k'% S _ Integrator: • Al"./
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = = Longitude: = o = & 0
Design
Current
=��
Design Current
Swine `
C*apacity
Population
Wet Poultry C*apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
/ $=
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
(3,o
❑ Dairy Heifer
Farrow to Wean
2-00
tZJ0-❑
Dty Poultry
Dry Cow
❑ Farrow to Feeder
El Non -Da'
❑ Farrow to Finish
❑ N erson-La ers
❑
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co t-1
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
1% No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
P9 No
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
Page 1 of 12128104 Continued

v
Facility Number: gz — /r j
Date of Inspection S 2 5 C?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IM No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [9 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L.c,S_41 4:!�s 5—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �.. _ % TZ 32
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[00
^No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[ ° No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
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
10 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes]
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
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) g[vww P ) .Sfaca/� Glzi�I (D�SJ �►iv , /.[f�CG �6L��c.v_'
13. Soil type(s) _ /t► A TWa �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q4No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments: f {
Use drawings of facility to better explain situations. (use additional pages, as necessary):
a
Reviewer/Inspector Name I Phone: 9/0 �/33 3330
Reviewer/Inspector Signature: Date: $— Z S— Zoa 4P
Page 2 of 12128104 Continued

Facility Number: FIZ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EX No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [,4 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22• Did the facility fail to install and maintain a rain gauge? ❑ Yes [;jNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 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?
❑ 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
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
59 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
EgNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
jo No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
T
Page 3 of 12/2&104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ? os— Arrival Time: Departure Time: County: _✓G..,�ASp� Region: )rW0
Farm Name: "Pe&4 scci;ne- F a .Inc. Owner Email:
Owner Name: L✓g,o,e,_ �w��+t re-." -rp?c-_ Phone: __1/0' S' -27-19
Mailing Address: P 0 Q X _-223 Newly,, , , , Gro ✓e Al L 2 g 3tr
Physical Address:
Facility Contact: *,n % Title:
Onsite Representative: nh• !,/ / '
Certified Operator: 6 ero %/ (Al~en
Back-up Operator:
Phone No:
Integrator: _81,em•;, _ Sfa .,,l4 Sc, ,'n
Operator Certification Number: / `l/45!
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =]' ❑ « Longitude: = ° =' ❑ "
Design Current
Design CurrentCurrent
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle C-apacity
Population
❑ Wean to Finish
❑ La er
iry Cow
❑ Vilean to Feeder
❑Non -La er
iry Calf
Feeder to Finish
I S,20&
1 14oD
❑ Dairy Heifej
2Marrow to Wean
la e>o
I j;ryj
Dry Poultry x
El Dry Cow
ElFarrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Co
❑❑Beef
Turkeys
Other
❑ Turke Poults
❑ Other
❑Other
Number of Structures:MOM
Discharges & 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
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
BN' o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LT No
❑ NA
❑ NE
other than from a'discharge?
r
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: : 2 3 `l
Spillway?: 20 070 n D oa
Designed Freeboard (in): I of" I ef�' f q,'
Observed Freeboard (in): &3 wZ All G
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 2
❑ Yes Q No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes 31�o ❑ NA ❑ NE
❑ Yes ENo ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [TNo ❑ 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 [i]No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
14y 9 l�ry 56 .76o fo 9z
12. Crop type(s) Lnrn GtJ/iea� BerwruJ�..// Goa.., sor��an3
13. Soil type(s) N,,, fol/( L✓a draw,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ENO ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
❑ No
❑ NA
[21NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
ErNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑'No
❑ NA
❑ NE
Comauents (r,;efer�to gaestwn�#) Explain any YE5 answersiand/or,�any?recommendations or any otlEer comments.
Iase drawingsof facility to better ealilain situations. (use add�tsodal pages asnecessary�:,
Re✓ e&,e OeS19'eal Frse6owol w:>`� Mr. L✓'I1:...,5. /��/ /asaews p�C c�ij.'gw�r% of /4.�� /�lir
G�wwf 4i coop 4cf NOS P44P.4 1 rf 44e lofsr*s {�tew..se of a.� w�wiw./...e,-A f/ia4 wat 4hf-idj
fo Ae p/.....
Reviewer/Inspector Name /y%arlt (� ., ', Phone: 9/0- tig6 /S f _ � wo
Reviewer/Inspector Signature:B Date: .?—Z2 - 4
IZ129104 Continued

Facility Number: S2 . — / 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B<o ❑ NA ❑ NE
the appropriate box. ❑WeP ❑ C rsts ❑ D�n ❑ ps ❑
21. Does record keeping need improvement? If yes, check the appropriate box below. Kies ❑ No ❑ NA ❑ NE
J•7 --�P 5t1 /.-7 1.D 041 1-13 G7 0." 1.1 a-W /o-1i-9 4311.0,1.V,40
91.1paste Application ❑ �t 3.iy�rerbaasd--, _❑� El Soil Anttiysis El Waste +zansfris ElAnnual Certification
Elfaii Rai�� Crop Yield t� fu Minute Inspections ❑ . Q 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 Pen -nit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
©<o
❑ NA
❑ NE
❑ Yes
E2"No
❑ NA
❑ NE
❑ Yes
2Io
❑ NA
❑ NE
❑ Yes
9-No
❑ NA
❑ NE
❑ Yes
E;'i io
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
✓ NE
❑ Yes
[2No
❑ NA
❑ NE
❑ Yes
Cj1qo
❑ NA
❑ NE
El2 Yes
o
❑ NA
❑ NE
❑ Yes
IGNo
❑ NA
❑ NE
❑ Yes
201o
ElNA
ElNE
ElYes
EJ/ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
'0 XRJI-/ poi.►, or PtCwr:o„y .i{o..�a��) conr�.'�ro� 1/PR"�ow�1
Tarim . i/ta3e vie 4A` r
+rlr� � �/ I•E forte G�� rh:/lar 120 n.:n.{c iws/!d�-o.�
Lafvr}q �
J.� Cowlw�Cr[r�R.i -i[.�:fzrr r5 t/S�U On /"Dw �/'q/s r P/lase 6e Srire �e eke
Al r°`{t offPi4N 41ple ee fur
Please r ^'ten+tor
P �G rC dfeoecu c 5 v eeclied
r
12128104

Type of Visit Q C.,omp�liance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit c3�'�ouiine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ,Z Date of Visit: A a Tune: .OD
Q Not Operational Q Below Threshold
�ermitted O'Cie/rtifieCd_ 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: —�
Farm Name: _.� !`! ...?°'� _�+`t� h lir�S . _L� g ....._� ......._ _.. County:.
Owner Name: Phone No:.... j gy —r%O
11la"g Address: _ �. �a �� / ■G• Gybvr age
Facility Contact: .. �M" ' G iNi �f e t� S . _ Title:. __. r +C G..._. _ Phone No:
OnsiteRepresentative: _. _An._t _....._ Integrator.
............. �,yrrv+cvi Sf••..a�-d
Certified Operator:._ Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude 0 ` "
_
Dessgn Current - Design -+ Current = f Design Cus rent';
Swine ,._ _ Ca
_
,, � a -:: •� �-- Pohl , � � = � = - _
:Po nlatlon, __ = ti3' Ca ai Po" alatioin- _ °Cattle sex - Po nLaairon,_
- -
_
' `' Layer Dairy ka
-
- Non -Layer ;r ❑Non -Dairy
IS T
—
Other {; t
E
- Toil Design Cagac�tty� 4
, :
T0>;a`ssw K
r lvnmber ail, ,
.1
F+ Y -s
xAN ..
s
riP.s
Wean to Feeder
er to Finish
ow to Wean
jt po
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discbaraes & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
[�
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
�To
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
Q40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
_
21 o
Structure 1 Structure 2 Stru tue .3 Suture 4 Structure 5
Structure 6
Identifier: _ �__ ---- _ .. _
Freeboard (inches):%ft31,;.,�.�s ! 0-+�+5
12112103 S'' � ; � -
Continued

Facility Number: gQ
Date of inspection 9?
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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Applic2tion
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �9" 6Vy_%11I eicksi-ki I Lit- &.41ct;eC
13. Do the receiving crops differ with those designated in the Cktified 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?
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.
�❑ Final Notes-� } _�-
❑ Yes ["No
❑ Yes [R'No
❑ Yes E No
❑ Yes [4o
❑ Yes 064o
❑ Yes [E(No
❑ Yes NNo
❑ Yes B140
❑ Yes [�To
❑ Yes [R4qo
❑ Yes Blf o
❑ Yes MORo
❑ Yes [91�0
Craf5 100?L 5.1 —7 (!l f 1 ,,'Vej
-- W,ow bats
ReviewerA Spector Name _
Reviewer/Inspector Signature:
Date:
❑ Yes [ 140
❑ Yes 0 No
❑ Yes GkKo
❑ Yes R<0
12112103 // Continued

Facility Number: — f ?, Date of Inspection �A
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes RrNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.) ❑ Yes B-go
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M<o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes E�No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ilo-
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes BNo
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative? ❑ Yes 2"No
28. Does facility require a follow-up visit by same agency? ❑ Yes [�Io
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes L<o
NPDES Permitted Facilities
30. Js the facility covered under a NPDES Permit? (If no, skip questions 31-35) BrYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes GYNo
32_ Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
33_ Did the facility fail to conduct an annual sludge survey? ❑ Yes Ej"No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes B1gO
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes Eff o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
12112103

Site Requires Immediate Attention: Ko
Facility No. 8 Z - t
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 11t , 1995
Time: 0 A
Farm Name/Owner:- W G-r ren
Mailing Address: P. o . 13ax Z Z 3 _ r1e uj#h n A re ye, .N _ C z 83
County: fkL"" - s nN _
Integrator:_ _ T4 _ _ Phone: (51o) 5 ` i(- / 7o /
On Site Representative:_ f­erwt1 _ t rtErce;r, _ Phone,
Physical AddresslLocation: _ 13 jb_ t3ew o ;'s Grove R;gl,.t 4�7m,,,,ef ?orlo', off
Rd.
Type of Operatio�i: Swins.%.- Poultry%
Design Capacity: ;I See kfaw
DEM Certification Number: ACE
Latitude: Longitude.
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
:(approximately l Foot + 7 inches) (2�>or No Actual Freeboard`!�Ft. Inches
Was any seepage observed from the la oon(s)? Yes or 1& Was any erosion observed? Yes or6D
Is adequate land available for ray? es or No Is the cover crop adequate? Dee or No
er
Crop(s) being utilized: $n r e. -- On
Does the facility meet SCS mini tback criteria? 260 Feet from welFmgs? JgDor No
100 Feet from Wells? 15. or No
Is the animal waste stockpiled within 1W Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of state by man-made ditch, flushing system, or other
similar man-made devices? Yes o'[`y If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or &i ** see W.
Additional Comments: R A#-V a ML 6, rwt -- W i t ( k Ge riff *eJ Soo n - t„) a r kt ne W/ N RCS (it
Inspector Name
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Number of Animals on Site: & _ see. be! oui _
DEM Certification Number: ACNEW
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