820057_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

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of Visit: OTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
In for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:� Arrival Time: Departure Time: County���ti Region / i '
Farm Name: , 5 ��n C �r `jouLi�,r f d`�— Owner Email:
Owner Name: //"p�1 l(Ji'�g 6^-� `��rrtC Phone:
Mailing Address:
Physical Address:
Facility Contact:/�r�/r�ra ���,.�C�r" Title: Phone:
Onsite Representative: �1�-� �- Integrator: �S�tY Tlc�p�
Certified Operator: `j/�Q� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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of the State other than from a discharge?
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Discharges and Stream lmaacts
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 JZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
[:]NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
❑NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E, No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
M_No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
2/4/2015 Continued

Facility Number: - ,� Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g No ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in): 9 -
Observed
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
15. Does the receiving crop and/or land application site need improvement?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [�j No
❑ 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)
acres determination?
❑Other:
9. Does any part of the waste management system other than the waste structures require ❑ Yes Eg No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
Callo
Waste ARAlieation
❑ NE
18. Is there a lack of properly operating waste application equipment?
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E&No
❑ NA
❑ NE
maintenance or improvement?
❑ Sludge Survey
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [21 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, etc.)
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
JZ�No
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z -No
❑ 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
® No
❑ NA
❑ NE
acres determination?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
Callo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
[:]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[j 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
0[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JZ�No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: -577 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C,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 D Failure to develop a AOA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[!�No
❑ NA
❑ NE
❑ Yes
LMj,No
❑ NA
❑ NE
❑ Yes
2!No
[] NA
❑ N E
❑ Yes EENo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes �allo ❑ NA ❑ NE
❑ Yes fff No
❑ Yes S No
❑ Yes [�J_No
[j NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
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Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
he J
Phone: hjp
Date:
2/4/2015

•
Type of Visit: VoCompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: GIrfioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: !O Departure Time:'Jit County: Region:
Farm Name: ��9�� G �-IIrj� y.�►�-�_ Owner Email:
Owner Name: I -r ig S'.p •'Phone:
Mailing Address:
Physical Address:
Facility Contact: L]�c�QP�" Title:
Onsite Representative:
P
Certified Operator:
Back-up Operator: `i%iY J1y rYr ✓`
Location of Farm: Latitude:
Phone:
Integrator: _zz2t�1/
Certification Number: 3 G
Certification Number:T
Longitude:
��QVSWHZLWUrrent
Design
Current
Design C►urrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C*apacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -Layer
Dairy Calf �..
Feeder to Finish
�,,
li
r�
Dair Heifer r`t4
Farrow to Wean
Design` Current
Dry Cow SII
Farrow to Feeder
Dr, P,oultr.
Ca aeitPop
+
Non -Dairy✓.
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow k
Turkeys
l2ther
Turkey Poults
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? (Ifyes, 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?
Page 1 of 3
❑ Yes B�]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [gNo
❑ Yes gNo
❑NA ❑NI?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
21412015 Continued

Facili Number: - Date of inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier:
Spillway?:
Designed Freeboard (in): 91 19 -
-Observed
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZ 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
Z 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
R] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
29 -No
❑ NA
❑ NE -
E❑
F -1Excessive 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
Z&A
12. Crop Type(s): "'n
13. Soil Type(s): ra
14. Do the receiving crops differ from those designated in e 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
R No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
(LNo
❑ NA
D NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
0,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists D 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes U No
❑ Yes �LNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2015 Continued

4
Facility Number: a - Date of Inspection: 3—/
'
24. Did the facility fail to calibrate waste application equipment as required by the permit?
'
❑ Yes
P7 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
J.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
Q 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 ® No ❑ NA ❑ NE
[] Yes [gNo ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes (3 No
[:]Yes 21 No
[] Yes O–No
C] NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: 1� Date: 3 p )Lb i
Page 3 of 3 2/4/2015

5
r�
(Type of Visit: (D-Ciompli Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Zu'tine O Complaint O Follow-up O Referral O Emergency ()Other O Denied Access II
Date of Visit: Arrival Time: Departure Time: 3 [) County: 5Lzo —
107
Farm Name: �DE%nl� j�l V/,Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: . /=N'O
Facility Contact: � h; l S� r_n.(' t Title: ©-i:U n r /'- Phone:
Onsite Representative: Integrator:
Certified Operator: �j"c--� Certification Number: _9-/ '�_.3��f
Back-up Operator: 'G f'/ . l ,/ Certification Number: C '
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
er
Dai Cow
Wean to Feeder
LLLN
n -La er
I
ai Calf
Feeder to Finish
aia Heifer
Farrow to Wean
Design
Current
Dry Cow'
Farrow to Feeder
Q . Poult .
Ca aci
P.o . _
Nan -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes [_No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ 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 ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facili Number: Date of inspection: /
( Waste Collection & Treatment
j 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5INo ❑ NA ❑ NE
I
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in); 1 C
Observed Freeboard (in): 2:3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
rZ 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
Lallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
®.No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window` ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. SoilType(s): C, �r� ���ae-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JZ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JZ No
0 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
[a No
❑ 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
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
S No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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 0 N
Page 2 of 3 2/4/2014 Continued

Faelli Number: - 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ayes [o
t
r' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (a 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 E0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Co 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
TO 6o`''1o�kr�
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes Z[ No ❑ NA 0 NE
❑ Yes ZLNo
❑ Yes ® No
❑ Yes @.No
❑ NA [3 NE
❑ NA C] NE
❑ NA ❑ NE
Phone: 3 33 Do
Date:
2/4/2014

3-13,-)s-
Region:
-IT)s-
jType of Visit: (EMoance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
(Reason for Visit: routine 0 Complaint O Follow-up C) Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 79;77 D Departure Time: County: 8 --
Farm Name: Lt y - /-,2- Owner Email:
Owner Name: � ZDj/ Divi Phone:
Mailing Address:
Physical Address:
Region: 1EE ,
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: �""L� Certification Number: W
Back-up Operator: /�?%G�;.,� S,•��iaGY� Certification Number: 2223/7-2
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity on.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
X
Cattle,
aia Cow
Design Current
Cap city Pop.
Wean to Feeder d G
Nan -La er
aig Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dt, P,Aultr
Design
Current
P_opity P_op.
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Non -La ers
Pullets
City
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other
Turke s
Turke Poults
Other
Other
Discharges and Stream Impacts
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 �g No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ 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 ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2014 Continued

Facility Number: Date of Inspection:
t
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E!]rNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19 �i�/79�
Observed Freeboard (in): 23- - AT l
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesinJ
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
0 No
❑ NA
❑ NE
R. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
J4 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?
J�g
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
&No
F] 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 Drib ❑ Application
Outside of Approved
Area
12. Crop Type(s): jr=W,—o.A- , �l!4//..�"l'' idftar-_ /:`'
�,/�
13. Soil Type(s): //l /1�It�t��r OLv/5•:d-
C=
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
DNA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R 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 D 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 RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

~ Facility Number: - Date of inspection: 3— — ,S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eg No ❑ NA ❑ NE
V
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F6 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
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
[3 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E[No
❑ Yes 0 No
❑ Yes 5D No
❑NA ❑NE
❑NA []NE
❑ NA [] NE
@omm'ents;(ref6r.46 question Explain.any YES answers and/or any additional recommendations or any other comments.
i -ii rawinns of facility to betterexvlain:situat€ons (use additional pates as necessary).
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/,P '133
Date: 3 — /,2— Z5_
2/4/2011

� S
Division of Wafer'Q+r�lfitp' � (�
Facility Number Division of Soil and Water Conservation
Q Other Agency
Type of Visit: t) Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: QRoutine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:t---- -i--I Departure Time: EEN County: �� $�� Region: rj?o_
Farm Name: S n Owner Email:
Owner Name: 04(fQI [''! j�ty.�_ n�.r_�� Phone:
Mailing Address:
Physical Address: q5 & S nI-.�r �` i
Facility Contact: WtIone- 50441& Title: M Phone:
Onsite Representative: f� t)162 U2Kj2_ Integrator: �4--'B
Certified Operator: CQ1rd I W, S10fl'1CCertification Number: Q6073
Back-up Operator: N i C � 1e_ Lora Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet -1 r CapacityEVE, Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder Q Non -Layer r'' Dairy Calf
`'` Dai Heifer
Feeder to Finish T � :,* _ � s � � �,� � A � ���€'�.
Farrow to Wean N, 1r �`
'' r " {Desi n Current �,, Dry Cow
Farrow to Feeder D hl?oultrC-11
a aci ��hPo x, Non -Dai
Farrow to Finish Layers ''„l Beef Stocker
Gilts Non -Layers "a'+ Beef feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes g No ❑ NA ❑ NE
Discharge originated at: ❑ Stricture ❑ 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) 0 Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes fgNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ®-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4120.11 Continued

Z Y
Facility Number: a Date of Ins ection: a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 10(
ObservedFreeboard (in): QV
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
QNo
D 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
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® 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 ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
1 — W
13. Soil Type(s): A' w .p f Wood
14. Do the receiving crops differ from those designated in the AWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10 No
❑ NA
❑ NE
20JDoes the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the apprQpriate box. '
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
RINA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: .k - Date of Inspection: � a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No M 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 p Lagoon/Storage Pond ❑ Other:
❑ Yes 15a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 1�'No ❑ NA ONE
❑ Yes E)—JNo ❑ 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
❑ NE
34. Does the facility require a follow-up visit by the same agency?] Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or -any -other comments , r >"
I]se.drawings°of facility to 6etter,explain situations (use additional pales as necessary).
I i, Q)e- spv, e '%W or cjoe aba`(-a Wyk post- ,e�( e 4iyp oy Pardo co�� ,
pica, 9e' -c- new same/l- whfn yon. ewy next,
'QS, La 01y) a ware- 0150 sl ��`ge'�o � � �l trea-6o - Yorilme. in 001-6. b,
yv 1 I C 9 gJea170,t YvIt 1, of-[*1,�., ,-�, aye ��
abeke o, s -Q
r
Reviewer/Inspector Name: V OGn SC� �1 (31{�,�' ___ Phone: 910-T1q3 31b1!Q'KI1_ )
4
Reviewer/Inspector Signature: Date:
Page 3 of 3 214/2011

Iro
a
r � few
Ila l)o'
1,39
si a
ars
�D
0.

.'j j j�L-
• Division of Water Quality
11 Facility Number - O Division of Soil and Water Conservation
Q Other Agency
type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: (� }2
J Arrival Time: p Departure Time: County: '
Farm Name: �R.,n Owner Email:
Owner Name: V11 Phone:
Mailing Address:
Physical Address:
Facility Contact: S t'aTitle: Phone:
Onsite Representative: t I
Certified Operator: If
Back-up Operator:
Location of Farm:
Latitude:
Region: 2
Integrator: I`rc �y 011
Certification Number: ` 0
Certification Number:
Design Current Design Current
Swine Capacity Pop, Wet Poultry Capacity • Pop.
Wean to Finish
Wean to Feeder 1.90 /
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Nan -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [P No ❑ NA ❑ NE
[]Yes ❑No
❑ Yes ❑ No
[R NA ❑ NE
(�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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ��` No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: ,Z- Date of Inspection: UZbjj
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 7❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
Z3 ��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes n 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes P
No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes® No [3 NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground E] Heavy Metals (Cu, Zn, etc.)?
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area `
12. Crop Type(s);
13, Soil Type(s):
14. Do the receiving crops differ from those
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.
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ 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 P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA [] NE
Page 2 of 3 2/4/2011 Continued

Wacil.4 Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 77r1(1� No
the appropriate box(es) below. F
❑ 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
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fait to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern`?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
yy
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
TT��
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 E ] No
0 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 0No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other cotrimefiU. =
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: qh --q3-?-3 3CV
Date: iZ40j, L
2/4/2011

Type of Visit: 4P Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: * Routine O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: I ff.A Arrival Time: t Departure Time: '/ County: Region:
t
Farm Name: S �} eylc� ! Y f 2 Owner Email:
Owner Name: C � s iix a. Phone:
Mailing Address:
Physical Address:
Facility Contact: 1.•�►,tr(4_ Title:
Onsite Representative:
Certified Operator: 14
Phone:
Integrator: Q .j L,._
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Ctirrent
Design
CuUqrrent
Design Current
Swine Capacity _Pop,
Wet Poultry
�ti.
Cpac�ty
1'4p
Ic i t"_apacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder ZfJO
Non -La er
Dairy Calf
Feeder to Fiiish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I-
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Becf Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Imaacts
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 the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No QqNA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [N No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes P No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of .1
1�
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
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in);
_
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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`?
E] Yes
(N 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
❑ N£
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[nNo
❑ 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 > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evence of Wind Drift ❑ Application Outside of
pproved Area
[r'
12. Crop Type(s):i
13. Soil Type(s):Angk=k,44 9�11�`s Wq
i
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
a
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
tn No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eq No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility tail 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 N 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 tail 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
DNA ONE
Page 2 of 3 2/4/2011 Continued

acilit Number: Date of Ins ection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes W No ❑ NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r----' 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
❑ YesNo
❑ 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
N 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
Ml No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ YesNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
1.0 No
❑ NA
❑ NE
33. Did the Reviewer/[nspector tail to discuss review/inspection with an on-site representative?
❑ Yes
E�3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: V-07-
Date: L7- 1
2/4/2011

- Division of Water Quality
Fiteility Number' O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other El
Denied Access \
Date of Visit: 1 fl Arrival T' e: rt U✓ Departure Time: ,S 11 I County: ��" Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: t r r`s`A Title:
Onsite Representative: V
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
Phone No: !! 11
Integrator 40
Operator Certification Number -
Back -up Certification Number:
Latitude: a o =1 Longitude: = ° = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Z D0� ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poulis
❑ 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 ofthe 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 Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: LTJ
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 'EpNo ❑ NA ❑ NE
❑ Yes ❑ No �1NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No 7 N
❑ NE
❑ Yes R iNo ❑ NA
❑ NE
❑ Yes '&No [:INA
❑ NE
Page I of 3 12/2$/04 Continued

acility Number:— Date of Inspection D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 S ructure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
( No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
I
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not property addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the Iacility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
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
ERNo
❑ 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)
❑ Yes
P No
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 [--INE
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.)
j
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptabl Crop Window ❑ Evidenc Win Drift ❑ Application Outside of Area
12. Croptype(s) A! 0L Lr/la,
tYp () OC �9'IQ^S � l>�ti V UQ
,r
13. Soil type(s) Alli, -I -o l — —/ "0%T , U-O� �'� ; �t�n O� • i !NM
"
----LYt
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 Iacility 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
R9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
. t�1 €= - a1 me era �l. ?f a d
Comments,(rcfer to question_ #) Explain ani YES ansvwer�san ar a y recamtnendatlons or any tither comments.
l3setdrawings of facility torbetter. expla n'situatinns - use adtlitlotittl a es as necessa
vf3i�{'xl,5r�,t'NEtiI.: �."
IReviewer/Inspector Name G$ '' Tai >' `'� �.' Phone: 0 UJ I
Reviewer/Inspector Signature: l}, Date:
Page 2 of 3 12/28/04 ' ' Continued

L
Facility Number:?— Date of Inspection
Required_ Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ftNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists❑ Design g ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A!9 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 pen -nit'?
❑ Yes
& No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Kj No
❑ NA
❑ NE
26. 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
❑ No
S NA
❑ NE
Other Issues
2$,
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
ID 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
fpNo
❑ 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®, No
❑ NA
❑ NE
rd.
Additional:Commen#s and/iii Drawings:
Page 3 of 3 12/28/04

if
Division of Water Quality
Facility Number �j�J 5 O Division of Soil and Water_ Conservation
-- Q Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit a Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: O I Arrival Time: . 30�. Departure Time: r'p� County: S4YYY-SCK)
Farm Name: _� CPr Akws J- s Owner Email:
Owner Name: L Phone:
Mailing Address:
Physical Address:
�i
Facility Contact: ay.C�5 Title:
Onsite Representative:r��
Certified Operator:��"a+
Back-up Operator:
Location of Farm:
Region:
I •P_ho(ne No:Q r
Integrator: nu'oWV
Operator Certification Number:
Back-up Certification Number:
Latitude: =0
=1 Longitude: =0=6
o=6 =
16
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer I
❑ Non -
Layer I F=3
❑ Wean to Finish
Wean to Feeder oZIDQ /co
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Giits
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other I,
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)
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifer
❑ D Cow
❑
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Capacity Population
Number of Structures: U11
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
W No
❑ NA
❑ NE
❑Yes
El No
'14 NA
0 N
❑ Yes
❑ No
NA
❑ NE
NNA
❑ NE
❑ Yes
❑ No
❑ Yes [O No
❑ Yes E, No
12/28/04
0 N EINE
El NA ONE
Continued

Facility Number: Date of Inspection to
❑ Yes
[�tNo
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Waste Collection & 'Treatment
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes
O No
17. Does the facility lack adequate acreage for land application?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
V5NA
❑ NE
Structure 1 Structure 2 Structurc ? Structuro 4
Structure.
5
Siniclarc
6
Identifier:.. 1
Spillway?:
Designed Freeboard (in):
?
Observed Freeboard (in): 49'�7 v� u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
qNo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[j9 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?
0 Yes
5ONo
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[)-d No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[X No
El NA
❑ NE
maintenance or improvement?
Waste Anulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes SNo
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �4 No
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidenc of Wind Drift ❑ Application Outside of Area
12. Crop type(s) i _ 5 t 5�w1._ � d . Wf041?l-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ��
❑ Yes
[�tNo
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
$a No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes
O No
17. Does the facility lack adequate acreage for land application?
❑ Yes
$9 No
18. Is there a lack of properly operating waste application equipment?
Cl Yes
§0 No
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):
❑ NA ❑ NE
0 N El NE
0 N 11 NE
❑ NA ❑ NE
❑ NA ❑ NE
F-1 NA El NE
❑ NA ❑ NE
Reviewer/inspector Name _ Phone: 3 i 53W
Reviewerlinspector Signature: OtD Date:
n u . a orrrrrrnuo.rrrr �rw. nrri
12/28/04 Continued

a
Facility Number: — Date of Inspection
Required Records _& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes oNo ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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 ❑ No RNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�g No
[INA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
t&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NINA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
5a No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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)
rd
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
91No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q9No
❑ NA
❑ NE
Additional Comments and/or' Drawings:
Page 3 of 3 12/28/04

(Type 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 [:1 Denied Access
Date of Visit:pl% oto Arrival
Time: Departure Time: .� Q County:
Farm Name:
��TT�� IP Owner Email:
Owner Name: — Cil rcS4e6-r21 Grz2nL, , _ _ Phone: _
Mailing Address:
Physical Address:
Facility Contact: S`►^'" rte+ Title:
Onsite Representative: } `t
Certified Operator: N c -{' 4 e- N-LLt C4 S
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
Region:
J
Phone No:
Integrator: I&C
Operator Certification Number: 183"
Back-up Certification Number:
Latitude: =0 ❑ g ❑ Longitude: = ° =, 0
Design Current Design Current
Capacity. Population Wet Poultry Capacity Population
F:Layer
Non -Layer
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
K 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 9 No ❑ NA ❑ NE
❑ Yes
❑ No
SPINA
[:1 NE
❑ Yes
❑ No
QP4A
EINE
EP4A
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
QfNo
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number:—
Date of Inspection 110123
NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
O No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P 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: o�
❑ NE
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.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
P 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?
❑ YesNo
❑ 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
❑ YesNo
LP
ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[--]Yes
UjNo
[:INA ❑NE
maintenance/improvement?
H. . 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
9PNo
❑ 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
5DNo
❑ NA
❑ NE
Reviewer/Inspector Name I ' r # �"' R� r Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �&o [INA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Stain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 14No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 55No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JSNo
[INA
❑ 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
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
nNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
In 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
0 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
Jn 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
4No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
Ad& l'o':rtal;Comrricnts.andMr Drawings19
Page 3 of 3 12/28/04
Page 3 of 3 12/28/04

I
W Divtsko of Water Quality
Facility Nutttber � 5 f k ,DIVI6E0[I of S6il a'h&Water. Conservation
wo
Q40ther,:Ag6c f s
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: a8' S�Q�+ Departure Time: ( r I County: 3A7v MPJ
Farm Name: . Sewc'er A t i _-mry 1 Owner Email:
Owner Name- l.Il.i' 1 ATF} n�PJ' 7� LTLull Pei) Phnne-
Mailing Address:
Physical Address: �+t� _
Facility Contact: Owls 6a,,, e� _ Title: Phone No:
4
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Design,- Cutr'ent`0
Capacity Population
❑ Wean to Finish
Wean to Feeder 3
❑ Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: FRO
=o =' =u p u
Latitude: Longitude:
Design Current
Wet Poultry i'; Capacity Population
❑ La er
❑Non -La et
Dry Poultry.:
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
Cattle
Design Current �,
Capacity ' Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Numbe r: 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 I No ❑ NA ❑ NE
❑ Yes
❑ No
ED NA
[I NE
❑ Yes
❑ No
NA
❑ NE
I ] NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�INo
[INA
❑ NE
❑ Yes
IN No
❑ NA
El NE
12/28/04 Continued

}
Facility Number: oZ Date of Inspection �� 7
❑ Yes
$3 No
Waste Collection & Treatment
❑ NE
ITNo
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No �1 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
EP No
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in):
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
B 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'?
ElYes
??No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
t9 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
12No [:INA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'M No [__1NA ElNE
maintenance/improvement?
14. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
J, No [INA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
$3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[B No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�) No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ,e Phone: (x%70) 7,53'_53,00
Reviewer/Inspector Signature: Date:
12/28/04 Continued

t
Facility Number: 6.2,-577 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 ❑ Maps ❑ Other +�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W 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 E�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EP 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
tNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
11INo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
09 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P 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
99 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
l] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings: . '
12/28/04

f
Type of Visit &C"ompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit S outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
10,
Farm Name:'f'ee_r 11 Ow,neer Email:
CA i"i S�flh e r(' ` hove
Owner Name: xa. �t rY
Mailing Address:
Physical Address:
Facility Contact: cl ti Title:
Onsite Representative: opL�<_
Certified Operator: /�
Back-up Operator: ceryl.
Phone No:
Integrator:, -,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
❑ I = Longitude: =0=1
o=1 = 1i
❑
® No
❑ NA
❑ NE
❑ Yes
Z No
Uesign
Current
Dcsign Current
Design Current
Swine
Capacity
Papulation
Wet Poultry C*apaty Popu�at�ion
Cattle C•ap�a�ci�ty PopulationCg
Wean to Finish
❑ Yes
CgNo
❑ Layer
El Dai Cow
Wean to Feeder
CgNo
❑ NA
❑Non-La Non -Layer
El Calf
Feeder to Finish
El Feeder
E] Dairy Heifer
ElFarrow to Wean
pry Paultry
❑ Dry Cow
ElFarrow to Feeder
El Nan -Dai
El Farrow to Finish
❑ Layers
ElBeef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
ElTurke s
Other
El TUrkey Pou Its
❑ Other
11100ther
Number of Structures:
❑
® No
❑ NA
❑ NE
❑ Yes
Z No
a��
❑ NE
Discharges & Stream Impacts
I. 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 ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[&No
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
12128/04 Continued

Y
L.J Yes
29 No
i
{
Facility1. Number: — Date of Inspection
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
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
o No [:INA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Spillway?:
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in): 3 35
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[3No ❑ 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
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
D4No ❑ 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)
13. Soil type(s)
14. Do the receiving crops litter trom those designated in the UAWMP'!
L.J Yes
29 No
Lj NA
Lj NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination '?
❑ Yes
10 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[9No
❑ NA
❑ NE
Comments (refer to question;#) Explain}any�YES`answers and/or any recommendations or any :other comments r
Use drawings of facility to better explain"situations: (use additional$pages'as'n(!.cessary)':
Reviewer/Inspector Name �'-�—..� Phone: }129`d/33-�.33p0
Reviewer/Inspector Signature: Date: 1,4-/—
ragez vj.3 !L/6d/V4 uorinamea

�i
Facility Number: ZL-5 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. 5a Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield Rj20 Minute Inspections ❑ Monthly and I" Rain Inspections 0 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 pen -nit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
EINE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
JO No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA EINE
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Additional Comments and/or Drawings:
r� �nS ���, � �. � (,tJ �a�k w,r � r �-,�t. ov ✓ lJru1.�,� 1�� �U�'`H^1
Page 3 of 3 12/28/04

n
Type of Visit 41 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 49 Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: Arrival Time: :3dq Departure Time: ; 00 County: -116a ,kR Region: d5P0
Farm Name: 4n f p, Owner Email:
Owner Hames r Phone: V e? -.2G 7= 0131
Mailing Address: 9�S__ T�� _ _��_. _ _I_�a,son �VG_ �$3L1/
Physical Address:
Facility Contact: S qtr Title:
Onsite Representative: Albol, Steen c ed�
Certified Operator: w./.s e-, S��E n G e t'
Back-up Operator:
cell
Phone No:
Integrator: Pee '.. s_
o�4r� - -
Operator Certification Number: -2G073
Back-up Certification Number:
Location of Farm: Latitude: =0
=&
= Longitude- =0=1
o❑1 = H
Design Current
Swine Capacity Population
canto Finish S`.?00
❑ Wean to Feeder I
❑ Feeder to Finish
i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other—
Design Current
Wet Poultry Capacity Population
❑
Layer '
❑ Non -La et
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?
Cattle
Design Current
Capacity Population
❑ Dairy Cow !
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ®1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ✓'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
[INE
❑ Yes
[,I No
El Yes
No
El NA
❑ NE
El Yes
,53
2<0
❑ NA
EINE
12/28/04 Continued

Facility Number: �2 — j<
Date of Inspection , ?-8•®s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: i✓ a
Spillway?: 02 o 1070
Designed Freeboard (in): /9 / q ''
Observed Freeboard (in): '31 ii Al
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ["No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes QrNo ❑ NA ❑ NE
❑ Yes ONo ❑ 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 Z 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ FtozePi'erourtd ❑
, te.)
t,_ „
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑re
of
' ~ F
❑ Outside of Acceptable Crop Window ❑ i ❑ Application Outside of Area
y > 0-7.7
f-/49 y-e3l 3.)/-]?(, -2-,2Ja ,t;d 3-/3! 1-la,Z-i3r
r "93,
s - `F� ,3
,
���
-1
12.
12. Crop type(s)o Hav sena /� Gre,'n Co�� .iB, w�i•�
>>s• �n�
r'
13. Soil type(s) /4 G G bc.r N 17 0 / k4a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9-5o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2No
❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',;[:] Yes 2No [:INA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 21No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2 No ❑ NA ❑ NE
Comments (refer to questlon #)c. Explaln any YES answers and/ar uny recammendatians arany other comments.
i]se drawings of facllity to�better exuin situatiory):
ns. (ase additlanal pages as necessaMA 3
P/eej tart ;f yup q041 0A1 viva?_ f/ t � /
R � LVl.trrr .f,
Reviewer/Inspector Name � 1 ;� ' �' dk f, ' ` I'" Phone: y/O - t/g(, - ! Sy/ axt X30
�.::
Reviewer/Inspector Signature: Date: 2 -2 -c7 5-
12128104 Continued

Facility Number: 8.2 Date of Inspection
Required Records & Documents
19. Did the facility sail to have Certificate of Coverage & Permit readily available? 2 'es ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2-1ffo ❑ NA ❑ NF
the appropirate box. ❑ wt p ❑ Gkect tsts ❑ Da&� ❑ *tapg ❑ 1a*r
21 Does record keeping need improvement? If yes, check te a ropriate box below. �es [__1 No [INA ❑ NE
fi t! -lo- O'1 y AI 1' e: ->/.8,/.7 ���� 7,(
�1Lvej =a e�4ppli—tion ❑ ❑ his ❑ Soil Anal s ❑ Waste Transfers ❑ Annual Certification
21ainfall ❑ Stocking [;�t;rop Yield P<20 Minute Inspections [J<onthly and l" Rain Inspections ❑ Vk-s+tr-G@4e
22. Did the facility tail to install and maintain a rain gauge'?
❑ Yes
El No
El NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
e 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
21N
❑ NE
26. Did the facility fail to have an actively certified operator in charge'?
❑ Yes
2'1�o
❑ NA
❑ NE
27.
Did the facility tail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
❑ NA
B"I�E
Other Issues
Please /eV4'vP N«ol �n
/!C w ern+ . lleelo
b"a'S4o 4rahs7PrS / /'Gi,nra�f' 1 /70 /if.gVT@ rr1,SACt*,urt arlG />7
'�3�relwl
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
2 -No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2igo
[:INA
❑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
ENo
❑ 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative'?
21yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawitigs:
04// Of Vq4 pIre V"Pds Pefrf•tS b.rrll t!er�;�,'cv'�g �! of COcC/age were oq-S,i<r,
��tG Gr rrcHi CDG 4r�a/ per�tNaS r10 104 cv re /410M el cepr 070 f ore
k,.'A 4 %Fw,, rte ,�f yov oleo,/ a csjo�. �v/�asr eon�d�f Owdl,
Please /eV4'vP N«ol �n
/!C w ern+ . lleelo
b"a'S4o 4rahs7PrS / /'Gi,nra�f' 1 /70 /if.gVT@ rr1,SACt*,urt arlG />7
'�3�relwl
o.776
ins �cY,' Nee
� re fist Nfro Srn r'a i'ef f'rvrr n e i.. L✓p,s� P/4.f 'pp leer./ //- ?ya3.
's
R
� R � slow o/d ti.us le /4,►
37 = f . SPt"for r7te4 rrts�cldr rJ,t rarM Ne't lef i/ o'.r, ,t
C OrT � u o nW' v
l/ P /o�vhr
12/28/04

V
Type of Visit p,Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visii QKoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: i+ o� Time: b0
Q Not Operational Q Below Threshold
GFIFre-rmitted Mertified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
FarmName:.........`4!......19.'........................................................... County: .....7`.#t1.................................. ......................
Owner Name: .........
SL ................. ........................... .................................. ......... Phone No:
...%.".......9.t..... .......... .... ............
....
MailingAddress: .......'....... 5�:�..:...... �`.�:......... I ! ...c... .................. ....�r.....1Y........................ ................. I ................ ......... I ............ I............
FacilityContact: ............ W:1Go "........ s 5�toQ�O ................... Title:................................................................ Phone No: ,..................................................
Onsite Representative: .......... 10v1 S�`Ca Integrator:
................... ................................ .................... !......574-�a! ...............................
Certified Operator:.. ............wi%N Operator Certification Number:................,.,....
................................................................................. ...................
Location of Farm:
� Swine ❑ Poultry El Cattle [3 Horse
Latitude • �' �" Longitude • �' �"
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 ❑ 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)
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 t Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................................................................................................................................................................................ .....
Freeboard (inches): 3� :44 i
12112103
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

FacilityNumber: - -
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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
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 IflrMu�� Sw4i4r,%4
13. Do the receiving crops differ witdi these 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?
Odor Issues
IT 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?
18. Are there any dead animals not disposed of properly within 24 hours?
I9. 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 UB-go—
C3
Bigo
❑ Yes BNo
❑ Yes [ E No
❑ Yes R<0
❑ Yes El No
❑ Yes
❑ Yes a No
❑ Yes �Q�No
❑ Yes IJ No
❑ Yes VNo
❑ Yes
❑ Yes MTo
❑ Yes IJ No
❑ Yes ErNo
❑ Yes [�Io
❑ Yes 2"No
❑ Yes [W&o

Facility Number: g —S-1 Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes M -Ko'
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑v rio
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [+'No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O"No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
[TNo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
E�No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[y;'<lo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
NPI)ES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
[91N' o
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
10 ❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
` t " 1
dditi6hiil Cainmt:ntsiand/or?Diawin
�: J dd ':4 ib i f ',., f' J it it._ t{I {4' 4 t' Ill ft( I3
€ €,,a , i' 1! 3 I t�' �,I< < j}, € iy ` Nn, �!¢ t� is I �.lE;ii.jF, [ �� 11pgJ ; , fFt�i�'j} E � :
.,es
.�11.:1i�i33'I,':IR'.(w•i131:.7«rTJL+.II.�Ii'ii7?tfill�Y.):SiJ:.J1:1'Sof:iF'w4'ifli7lcik'+f:I.
t tIE1w.;NiWT�.{A€{31�stu�ttiu3:Sid'it7l'F'=5�.'('I:'i:€[r��,EillHli!fil}�d+....€ilt_d:34W.�t�''IItu:I-':i'L41Pit�i:3�rl.F�i�q.'.�I,,i�ii�.i�i.IL.II
S,,l s��s a� a.,� I; �•�. -t-, 6c-
c-(24
A&
(2 4
12112103

Site Requires Immediate Attention: NO
Facility No. 82 - 5 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: 9: 00 — /O: i 7—
Farm Name/Owner: SpzNCe.r Noescty
Farm
'Mailing Address: R t. i Baff -778
County: Sa,y so.ol
'��/2 % 4Vi'lsom fAe.yice r _
NC 2 S 3 V1
Integrator: Fay: /
F yo.,
Phone:
On Site Representative:
eA�
Phone: _l9/O> 2 67 - 0 93I
Physical Address/Location: S
e-,vCe.. r f<OM L - S R 113 �! OP . 03 rent 3/
Type of Operation: Swine ✓
Poultry
Cattle
Design Capacity: 5 200
Number of Animals on Site: 5, ZOO
DEM Certification Number: ACE
DEM Certification Number: ACNEW
Latitude• " Longitude•
"
Circle Yes or No
Does the Animal Waste Lagoon
have sufficient
freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
es or No
Actual Freeboard: Z Ft. O Inches
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: Cc, as -/.q
I? Yes orQLo Was any erosion observed? Yes or io
No Is the cover crop adequate? es or No
Ccli �/ �r ✓ 9 y e --
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? (Wei No
100 Feet from Wells? &or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oKjP
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes onj§D
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oxg 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)? (e or No
Additional Comments:_ 1- �4ddr4,! �,j l /Q�vp v ti -ad 3 Poo+ of-F'e.c_ o., -a
Inspector Name Signature
,cc: Facility Assessment Unit Use Attachments if Needed.