820178_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

;.;l-•";I��,i�i�lrljll,�llliil='I�s,
a:I'i'I•Y� �°II�°IFICII I�aI IIIff!cI'� j,ti Ilf 1�,� tti,� yY1I1 YXD' N".�I',A{,IiiIt�ik�um.!1IYFu4b, 1��1_�1!U '1iYl�i;ppl!1-�l1; :� � �S I!1'p"1. s�`- 1 ";'"'. 1 iHu I ,.,I� I Ilii�'� 4 °1 � ! + �sI on o,f +W"- s. '
tet Res o� ,n. rccs
QDivisionof Soiland Water Conservation
u
er a03 ,theC Agency;
0
r
peof Visit: 7Routine
Hance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
ason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: f 0 County: Region
Farm Name: CWv~<�` �� CO Owner Email:
Owner Name: G /�� ,�y -. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: /if
Hack -up Operator: Oy cQ �� �. �I ✓��o{' y
Location of Farm: Latitude:
Phone:
Integrator: v'
Certification Number: '?0
Certification Number: 7 7VIZ _
Longitude:
1 1L
IIiiI
1,� II1
I!I
+ '41 I I I 'j!11'D1 n f! IF CurreInt
�ll���E !�!
1II
,I. I Design., . n Current',
_ Design,, Current
[f• - ,
I', Ir I1I I1 �'.'�.,�,',,''.,,
I:,kktCap"city Pop
I
WetCapacity;Poultry
,,
Cattle Capacity -Pop.Swine
_
.
l�Ia�
.',L
L ,'l .!l,
1•,
1'
k!�}
Wean to Finish
Layer
Y
i
Wean to Feeder c7�i D ,'IE
,1Non -Layer
I
Feeder to Finish
Farrow to Wean
l,`���yy!!' a�Yl"�111 1 9,II P !
I��� II,� I 1
�I`:1 "� ���") i !'�� Y1(' Desiryn' Current
I
g T.
i - �I �h II I, Y [ {�b+11 i 'its
Farrow to Feeder
u�'I�N f 1Iy {�i
�"lt ,,,I�iCali.: act ,l` .1'0 ,r
�'; �rwers
Farrow to Finish
i;�'�
Gilts
I�I';
�I
1
Boars
IEIPullets
��E��I,�
f , I
'���' �XI�6I,I
'" °+�14 �f1��G„1��Ii,116�;I
li';f,
I,11 ,,��II.
TurkeyPoults
if
Other
�: °' Other
_Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood
❑ Yes ®'1 0�❑ NA ❑ NE
Yes ❑ No [3-NX ❑Nis
❑ Yes ❑ No E]-NA ❑ NE
❑ Yes
[] No
❑'NA
❑ N};
❑ Yes
[DN
❑ NA
❑ NE
❑ Yes
ED"N-o
❑ NA
❑ NE
Page 1 of 3 2/4/2015 Continued

Facility ;Number: Ds ection: 4
Waste Cullectlon & Treatment t
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-1q_o ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No Q NA ❑ NE
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 4 Structure 5 Structure 6
Observed Freeboard (in): d -5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [i]'lGo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E rNo ❑ 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
L "O
7. Do any of the structures need maintenance or improvement? [] Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0_1<0 ❑ NA ❑ NE
(not applicable to roofcd pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes i.d o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes qo
❑ 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): VtLje , D
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E]-<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
D Yes L3 "'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes D<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0<o
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Na
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D 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 C r N
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F No
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacilitvNumber: TJ - 1 Q 1113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E9 1 Imo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑-lVo
❑ 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
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:
❑ Yes
Ca'No
❑ NA
❑ NE
❑ Yes
[%%No
❑ NA
❑ NE
[:]Yes
0No
❑ NA
❑ NE
❑ Yes
[fNo
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0�40 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EfNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�:fNo ❑ NA ❑ NE
G-- �'n - P - M 39%
( 9r0-306>= �q ffI
Reviewer/inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
71
Phone: 0- -33 '
Date: i,�
a�
2/4a015

IS 5 P-1.
UrDivision of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
Y 0 Other Agency
Type of Visit: O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '��,� Arrival Time: Departure Time: % County: J Reglon: ` T�
Farm Name: 9 Q�n^W^a AI.S t&C.Ov( Owner Email:
Owner Name: C r!a✓ti�ev[C� 4-.0 C . CC-AVISA Phone:
Mailing Address:
Physical Address:
Facility Contact: Lets C4t(4V1 k j& Title: . Phone:
Onsite Representative: Integrator: f-
,Mk A J2
Certified Operator: i Certification Number: l
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
o d v Non -La er
Wean to Finish
Wean to Feeder
Feedcrto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Pullets
Poults
Design Current
Design Current
Cattle Capacity Pop.
jDairyCow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
[] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[] 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)
C] Yes
[] No
["'NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EI'No
❑ NA
❑ NI,
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

063
Factli Number: - Tate ction:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
❑-15o­ ❑ NA ❑ NE
❑ No 2-1gA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes `f�:rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes "No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 [:fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No [DNA ❑ 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): U-�tl'ILG V v
13. Soil Type(s): [�►l�t.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []!f 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 [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E5"'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[?fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z N' o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�j 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 No [3NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
24,, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ D-No
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E O
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 �o
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [allo
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[?-No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
E:fNo
❑ NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[l"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewtinspection with an on -site representative?
❑ Yes
El"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
hlo
❑ NA
(] NE
Comments refer to question # : Explain an DYES answers and/or an
( q ) p y} y additlonal'recommendations ar any other comments
[UsleArawingsof
fit,
facility to better explain.situations`(use additional pales:as neeessary): ; F= , p
; ,; _, 2 t1.; 4,x ,, °; ' a, a
C'9_4'0WV4,a2n. t �_-
S14t Ssl — ! (-I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
9M
a- I'( D
C�cl
10-- 30 9 _ 9-51
Phone: 1 J 3 S33 7
Date: +V E7
21412015

tf ^e G [ b f �)
M.Wision of Water Resources
- n Fpcility Number ®- /� 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: (Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: .Routine 0 Complaint 0 Follow-up 0 Referral 0 Emersencv 0 Other 0 Denied Access
Date of Visit:_j Arrival Time: r 30, Departure Time: County: Iyi RegloF--!2
n 1
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �411 4
Title: Phone:
Onsite Representative: 1 Integrator:llE� _
Certified Operator: Certification Number::
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Deslgn Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes � ❑ NA ❑ NE
❑ Yes ❑ No � ❑ NE
❑ Yes ❑ No EKA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [301% ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ff No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No gEJ.N'A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
a1%W
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3'VU
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes'
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E is
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R54d6"' ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R! ❑ 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) � Gl �V 1 '�i f �P C i.C�e-
!3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z[o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[;I-hto
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
QNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'Ko'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
u No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q'j`fo
❑ 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 �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis []Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
• 24. Dl d the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M.Ne ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ 1]-Nff—'❑ 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-complianec:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes CZJ415❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] j Mo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Q"o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
E3,Ne-
❑ 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
I� o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
]I o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[:rNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[: No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. ,
Use drawings of fa I! to better explain situations (use additional pages, as necessary).
C,k (6 6 45
S(u_ • lS- /I'S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

ME
—'�_6 - s
(A"Ivislon of Water Resources
Facility Number - ® 0 Division of Soil and Water Conservation
Q Otber Agency
Type of Visit: omppliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 04 outine O Comelaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: S W Region:��
n t
Farm Name: (i a Lk, -'C -9tt Oki Owner Email:
Owner Name: L,te, CA �M Phone:
`
Mailing Address:
Physical Address: /
Facility Contact: L�L'�Ci CQ�
Onsite Representative: l
Certified Operator: 1 `
Back-up Operator:
Title:
Phone:
Integrator: J /
Certification Number: Ao r b7
Certification Number:
Location of Farm: Latitude: Longitude:
i'�. bcpw 8 brig � ►t+1• r� a
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder logn J16(2
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
I I Layer I +_
Non -La er
Non-L;
Pullets
Turkey Poults
Other
Design Current
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes [3-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [2,NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [ No . [�� ❑ 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes
❑ No
[:]Yes
io
❑ Yes
�io
M-IqA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

1Facility Number: jDate of inspection:
Waste Collection & Treatment �,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [3 Yes [ 1"o ❑ NA E] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3-KA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes r=Ko ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E]I�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[L]'1`lo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�io
❑ 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
[25>o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1..-"o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
Crop Window ❑ Evidence of Wind Drift ftt, ❑ Application Outside of Approved Area
12. Crop TYpe(s)= i7 29l-1AL45
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2-No 0 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Eg-�Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [d],Wo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [211�o ❑ NA [D NE
❑ Yes Ej]-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes Cg�Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g--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 o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [3 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 <o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q o
� ❑ NA ❑ NE
❑ Wcather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - r7 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3-Ko— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes ❑ No Q-NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [vrf4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E3<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M-lo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes
O 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
[3 o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ffNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2'l<fo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
[1"No
❑ NA ❑ NE
Comments (refer to question Explain.any YES answers and/or any additionai'recommendations or any other comments. _
Use drawings.of facility to better ."explain situations.( use additional pages�as necessary) ,.�,
c 1,P rot,
s V �5-tgu /V U1-
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Page 3 of 3
6'.
`1 D V Phone: `�+ �� 3 33
` Date: �0
21412014

vision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
I V 0 Other Agency
Type of Visit: Com lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Ct3'Rou ine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: T Arrival Timt5.'On
Departure Time: Coun Region:
Farm Name: iir�...A a�el 4_�
� S'L'Owner Email:
Owner Name:
Mailing Address:
Physical Address:
A
Phone:
Facility Contact: �6& I; CLA.d' Title: �/� � Phone:
Onsite Representative: Y Integrator:
Certified Operator: Certification Number:�� 6�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La cr
Non -La er I I El
Non-L
Pullets
Other
Poults
Design Current
Discharizes and 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [Dr No ❑ NA ❑ NE
❑ Yes [:]No []'MA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [:A ❑ 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 01 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes QjXo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

T i I
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes O_" ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [3.Pi6 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]-.Na
❑ 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
10
❑ 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
[]Ibla-
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ej�
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Y.No—
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
lT 5o
❑ 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
U. Crop Type(s): �W` (2 {! J S
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ED. n
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L "1-
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
MXo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑Xo
0 NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
©IQo
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]Ko
❑ 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 E3<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [] 1< 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Cg�4o [] NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins eetion:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U�o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑"5o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®'Ro
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E5-<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes B<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [R-55 ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments M° gam,'`
UseArawIngs of facility to better explain situations (use additional pages as'necessary). i t ir,t
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Name:
❑ Yes [ZLDW ❑ NA ❑ NE
❑ Yes 3 To ❑ NA ❑ NE
❑ Yes M—No ❑ NA ❑ NE
❑ Yes Cg-Ko ❑ NA ❑ NE
Reviewer/Inspector Signature- }�� Date: — 1J�,AJt1
Page 3 of 3 "�"� '"' 2/�1412-0-'1_1

�w
r
Division of Water Quality r.d.1 - ( F0—t
73
Facility Number ®- 1 7 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Q<ompliance inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County
Farm Name:. per' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:'lZ b
Facility Contact: �-e- &ezo a64Title: Q/,1J/1�i� Phone:
Onsite Representative: Integrator: A-Z747-5.4.
01
Certified Operator: .��� Certification Number: z
Back-up Operator: Certification Number:
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
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
D D Non -Layer
Design Current
Dry Poultry CanaCity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Im acts
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
Daiai Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [] Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes �No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: M - J Date of Inspection: (v--
.� Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes M.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?
❑ Yes
V No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
IM 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
2q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
XLNo
❑ 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): f �v(�122C1/
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? []Yes 2LNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E[ 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:
2 t. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gL 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 RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C!FN0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: g7= - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to, develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ;@ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes r 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?
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes MLNo ❑ NA ❑ NE
❑ Yes [5j No ❑ NA ❑ NE
❑ Yes �4No ❑ NA ❑ NE
❑ Yes i1 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes CE-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments;(refer.to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7ILW'D_— '-pQ'O
Date: to —"-aa
21412011

Ivision of Water Quality
Facility Number ®- 1'Zi6 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q.Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: Q County: r7P+mPgan
Farm Name: C.� R �� C e 1, C A n n a �� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 1'y F_ Title:
Onsite Representative: C k o RF—mC Q
Certified Operator: a Sam it
Phone:
Region:
Phone:
Integrator: -p(R rsAP A E
Certification Number:
Back-up Operator: Certification Number:
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
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Pullets
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes W No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes [M No
[:]Yes L No
MINA ❑ NE
[� NA ❑ NE
®NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

M
Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ 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): a�.P
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes q No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
K] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [3 Evidence of Wind Drift [] Application Outside of Approved Area
+
12. Crop TYPe(s): C)LQMu �ODUZbssc o `iRL\\t
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JX] 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?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes MMv I 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
[DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
Vy
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [M) No
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
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ®No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? []Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalarecommendatioos'dr any other comments:
Use
drawings
�of facility to better explain situations (use additional pages as;necessary).
laaa� r �1Q�
g fta-ll 'I'Mi-
1Ga
S
A5
vt �o wc,iZ� o �- AR�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A0.av�4�) LAyor
\caS Phone: 91()-
Date: U
2/4/2011

r,
't. Facility Number
Cj'1Oivision of Water Quality
®- /T O Division of Soil and Water Conservation
Q Other Agency
Si"L45-11
Type of Visit: ompT nce Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: 1 PC?
Departure Time: D : Od
County:_ S�a.t Region:
�'-�—
Farm Name:
�y iS �a e s ry
Owner Email:
Owner Name:
wGIC CtLr Q�y
Phone:
Mailing Address:
Physical Address:
Facility Contact: �� r• C� �. ,. L Title: Okwt C%" Phone:
Onsite Representative: Integrator: Oe371.7�
Certified Operator:-$.�,,.G� Certification Number: �12 f4�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
b 0
Pullets
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes g_No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes 5jNo
❑ Yes Imo, No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continuer!

Facili Number: - Date of inspection: it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
®..No ❑ NA ❑ NE
[]No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C3 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 2. 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): jV,.oi',"0t,1et �iDt/c✓: e��I�i:��,�T,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [3 Yes allo C] 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 Ig No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S[No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
B No
❑ 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 ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fo 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 E, No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: /
f 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ®..No ❑ NA ❑ NE
❑ Yes EKNo [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[]Yes [&No ❑ NA ❑ NE
❑ Yes [No
[]Yes [� No
[:]Yes S INo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
t:�O
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or anybother,comments
Uge-drawings of facility to better explain situations (use additional pages as;necessary):- - . "
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 22p !Q3 := 0
Date: /y2 '2 —Ail
21412011

Type of Visit &Co—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (3P116utine - 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: . Dd Departure Time: ate County: Region: L�
Farm Name: 494',10a lY �S ,�n 4 Owner Email:
Owner Name: �a /`�i2r Phone:
Mailing Address:
Physical Address:
Facility Contact: l gT n a� -, Title: Y% Phone No:
Onsite Representative: Sc-z - Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c = d Longitude: = ° = I =
INDesiWIMURNt
Design C*urrent
Design
Current
Swine Capacity Population
Wet Poultry C►apacity Population
C►attle
•apacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy -Cow
Feeder &D
❑ Non -Layer
❑ Dai Calf
o Finish
❑Dai Heifer
o Wean
Dry Poultry
❑ D Cow
❑ Non -Dairy
to Feeder
to Finish
RED
La era
❑ Non -La ers
❑ Beef Stocker
Beef Feeder
❑ Pullets❑
Turke s
❑ Beef Brood Cow
11FO-0—ther
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No [Z NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[,NA
❑ NE
❑ Yes
❑ No
54 NA
❑ NE
Pugs, / of 3 12128104 Continued

s
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Uff'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
(B,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[&No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
allo ❑ 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) L- iY! Co r A.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ES No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pj�No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers andlar anyrcommendations�or aty�otherF comments „
Use drawings offacility to better explain situations' (use Ad[iitlonal pages[YaXsg,necess'ary) ;
3 : t-;G ✓--RYA �,.Sval.{CF)�i'^f'�YAa.k kF,S.,,.?FR�e.*t'��.^�uwz$^t'V�Y..W
IF
75
Reviewer/inspector Name � ►� x - E --
' �. r«: Phone:
Reviewer/inspector Signature: Date: /D — i "57, —0l D
Page 2 of 3 .41 12128104 Continued

F Facility Number: — Date of Inspection
t+ Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [8: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
J,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E8 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�No
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[HNo
❑ 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
5,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
C&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
[9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
Page 3 of 3 12128104

Type of Visit ompilance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit GHIGutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Qther ❑ Denied Access
Date of Visit: Arrival Time: 'O Departure Time: D D County: Region:
EKD
41
Farm Name: a,-) Owner Email:
Owner Name: C Latre ie'e C0-" Phone:
Mailing Address:
Physical Address:
Facility Contact: Ne Title: *'- Phone No:
Onsite Representative: Integrator:
Certified Operator: -s` Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = ' = Longitude: = o = ' =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattie Capacity Population
❑ an to Finish ID Layer
Wean to Feeder D p ❑ Non -Layer
I
❑ Dairy Cow
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Pfeifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
ElNon-Dai
❑ La ers
❑ Beef Stocker
❑ Non -Layers
❑ Pullets El Beef Feeder
❑ Beef Brood Cow
❑ Turkeys
❑ Turkey Poults
❑ Other Number of Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
JKNo
❑ NA
❑ NE
12128104 Continued

Facility Number: f —
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stnicture I Stntcture 2 Structure ? Structure 4
Structure
5
Snructure 6
Identifier:
Spt w7y ?
Designed Freeboard (in):
Obsmed F'reeboarcl (in): lip
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNO
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Cg 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
D No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ 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
❑ NA
❑ NE
maintenance or improvement?
Waste Aaolicatiun
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)_Zardz ,ra
13. Soil type(s) Vjel
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
P9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
59 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ER No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
®No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name_. Phone:
Reviewer/Inspector Signature: Date:
' 12128104 Continued

Facility Number: ee," -17 Date of Inspection
s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
.20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
❑ Yes R No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C8 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel 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
0 No
❑ NA
❑ NE
❑ Yes
J.No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
29No
❑ NA
❑ NE
❑ Yes )Z No ❑ NA ❑ NE
❑ Yes f@ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
5� No
❑ NA
❑ NE
❑ Yes
54 No
❑ NA
❑ NE
12128104

O Division of Water Quality I I
Facility Number ? 0 Division of Soil and Water Conservation
Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency 0 Other [I Denied Access
Date of Visit: Arrival Time: ; �� Departure Time:dE 'Q County: Region: D
Farm Name:!'%/1�af�Gl G�� Owner Email:
Owner Name: i&29Ce'0.1( _ Phone:
Mailing Address:
Physical Address: /�
Facility Contact: Lie 6Z2&,eU,4 Title:
Onsite Representative: S.1 -
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
Boars
Other
❑ Other
0
Latitude: =
Phone No:
Integrator: 4Lndz_
49,
Operator Certification Number: 9
Back-up Certification Number:
Q" Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3a 0 ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: a]
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 allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes
M,No
❑ NA
❑ NE
Page I of 3 12128104 Continued

\r
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): l 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes C.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
[]Yes CRNo ❑ 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 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [2 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 JQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) f ��t//i7% ��C�>/ Y �J24r 4f H7d (:� � ►�
13. Soil type(s) 104 2
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes [ZNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes MNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [Z No Cl NA ❑ NE
ReviewerlInspectorName �; [r:,d��` °+ "� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

' Facility Number: — 7 Date of Inspection _-a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ESNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes IgNo ❑ NA ❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[INo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
59 No
❑ NA
❑ NE
❑ Yes
UffNo
❑ NA
❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
SjNo
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number r% 0 Division of Soil and Water Conservation
Other Agency r"
Type of Visit
iCommp�pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
1!r'rcoutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3 D Departure Time: Q County: Region:
Farm Name: Get" a a le s ZCc Owner Email:
Owner Name: �!� t-en ee Phone:
Mailing Address:
Physical Address:
Facility Contact: C L re >Z Ce- e-.ah naJYTitle:
Onsite Representative: r
Certified Operator: S
Back-up Operator:
Phone No:
Integrator: Aln,.,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o =' = Longitude: =° =' = "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1 IDNon-La et I I El
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?
Cattle
Design Current
Capacity Population':
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes SNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
12128104 Continued

Facility Number:— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: p
Designed Freeboard (in): 1
Observed Freeboard (in): 3 l�
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 SNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 54 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 QjNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. CroptyPe(s)J1211�rt���.�n���r;+�� i��Gfi/ 6(/Fn��rpc�rYS�r�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes N No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 9 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 56 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name �vG (� k Phone:
Reviewer/Inspector Signature: Date: e
1Z/Zd/v4 uOnfinuea

Facility Number: — f 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 ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
j,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XjNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J, 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
J0 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
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?
❑ Yes
J.No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit O<o'mpllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,' Departure Time: County: Region:
Farm Name: CO PI r1ud v S 7) I�Lw Owner Email:
Owner Name: G z2✓ ert C e_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f-�-
Certified Operator: SAI. —
Back-up Operator:
Location of Farm:
0
Latitude:
Phone No. -
Integrator: - 7,'—.._
Operator Certification Number:
Back-up Certification Number:
❑" Longitude: 0° ❑, ❑
Design Current Design Current
Design Current —l-lt
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder D L D110
Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
❑ DEKCow
❑ Non -Dairy
❑ Beef Stocker
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
ues
El Beef Feeder
❑ Gilts
❑ Beef Brood Cow
❑ Boars
Other
❑ Turkeys
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 R No ❑ NA ❑ NE
❑ Yes
JQ No
❑ NA
❑ NE
❑ Yes
VQ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
M. No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
9,No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
4 Waste Collection & Treatment
-1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier,
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3�
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 RNo ❑ NA ❑ NE
❑ Yes (KNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 10 No El NA ❑ NE
❑ Yes Or". No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5Q 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 PC No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes V1No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? El Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? XYes *00 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes [M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes WNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ® No ❑ NA ❑ NE
/f'- �uD''1C9rt �z-rrrl�t�tr ,fr,�.;7- ;3 Alew�l.
Reviewer/Inspector Name
nspector Signature:
Phone:f�G /S�l
Date: (v— % —.;701) (o
12/2"4 Continued

Facility Number: —J7 Date of Inspection [ -D
• ( Reguired 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 gNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2�No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� No
El NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(a No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
MrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
04No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
CKNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
g No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: r Arrival Time: Departure Time: County: S a r I a &J Region: V70-`�
'b- c is -s11161 J 01
Farm Name: _ C ay-, 0.Aac.nIli Owner Email:
Owner Name: Phone: _ qt o - Se q- 24 aP 7
Mailing Address: 2 7 7 ] u� 12�i _ G l; +nri N C .29 3.71?
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: C Integrator: _ — Pra_6± oe�
Certified Operator: C \ , -_tom a Operator Certification Number: _a ale
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
=0 0i ��� g =0=A
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
0 a ot�o ❑ Non -Layer
I
❑
Wean to Finish
©
Wean to Feeder
El
Feeder to Finish
El
Farrow to Wean
❑
Farrow to Feeder
El
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made'?
Cattle
Design Current
Capacity. Population,
El Dairy Cow
El Dairy Calf
El Dairy Heifei
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
[I Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
12128104 Continued

Facility Number: $.1 - 1700
Date of Inspection SI 1 a s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[d No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure_ 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Ll g//,Z J o3
Observed Freeboard (in): yQ ~
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[E 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
[A 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
54 No
❑ NA ❑ NE
8. Do any of the stuctures 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
❑ Yes
W No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
X) No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
X No
❑ 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
Hare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) _.002A: oR L•+i� • Idea J-r "Q0.6 IQ ras.r-:L..
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑��Yees
X No
[I NA El NE
15. Does the receiving crop and/or land application site need improvement?
®1'es
00 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
50 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;�] No
❑ NA ❑ NE
a question:#.) Explain any YES answers
/S-/ C.. e n -> f, ^ M. c o &.+ o e k-+ C-S !<a ► +f �. �s y o r o u. s io c. r i•�wS�.�
h e►,p W 14,L % C b t
ReviewerlInspectorName:.^:r
Q r�. Phone:
Reviewer/Inspector Signature: Date. g/D t
12128104 Continued

;r
-ti.
Facility Number: R- /78 Date of Inspection
Required
Records & Documents
I9.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
5Q No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
FK] 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
[9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[g 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
[9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104
12128104

♦ S i se I ;.:�:!? i §1 .?F4iEi Pfl;: k s.si. : i4 ;�! ...iil If!€i i f :a, 8:�-. �i.€t.,��, s€ titi3e:p'.f. }t€ :'e+„ 7 --..€€ , �i °3. �,1 ...:3 € € € € t:�ti ; tc€ !i DiiOf..S
�!1�9 � �# s ig;l r (� }� �s E ! � ;1 ��� 1 •� � I j l € ir..
�V�sn O3W8ter
..i: ,v
`'L
Dens>ton, of Soil3andxWater;Conservation
l n gay �t th n 5 1
#.\/i OI.i�&d�Aenty€
iJ.�..... .. f: .. .€... .-.... a. a.. xiI.
Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number rj Date of Visit: Time:
Q Not Operational O Below Threshold
['Permitted [Mertified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
County:....s
Farm Name: ...... Cit711Fi,t��r... s....................sntt.!.......................................... a.n`.a............................................
Owner Name: ............. C.61na!%..Ce.......... ..... Ca.nnk!sl/............................................. Phone No: ...... q/..v...,r�G. fir. :/........... I......................
MailingAddress: .....rr2.2.7..�.........4API m........n1 ...............C. a.' f.dn............ N(.............. ez,h.3.rak............ ........ I................. ..........................
Facility Contact: ........... Cd.lif..:Jt (. nC.........4.u^ Atli .... Title: ...........................................................0.... Ph,/one No:
Onsite Representative: ...C.1.a�°..eft............. �,G.[.?.ClEtter................................... Integrator:..f.l:i.!�............................................................
Certified Operator......... .�ft�JG!1.G. ...........�l n xer//.............................................. Operator Certification Number: .... 2b Z6.7..................
Location of Farm:
Is/Swine []Poultry []Cattle []Horse Latitude • 4 " Longitude • ' "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes G-Ko'
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [moo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [?To~
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes e-No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [gvo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑N6
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:..................................................................................................................................................................................................................
Freeboard (inches): 3G
12112103 Continued

Facility Number: 8.2 —
Date of Inspection •�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑-10
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes g-No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes G1-96'
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes U-Na
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑qX—
elevation markings?
Waste Analication
10. Are there any buffers that need maintenance/improvement? ❑ Yes U-No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes +moo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type f04S�a ^0A, Sf" (rra,;n 4iirrS«4/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑-No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes S-No
b) Does the facility need a wettable acre determination? ❑ Yes E�No
c) This facility is pended for a wettable acre determination? ❑ Yes 2-No
15. Does the receiving crop need improvement? ❑ Yes UNo
16. Is there a lack of adequate waste application equipment? ❑ Yes G-No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O pits
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes NNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Siq�`
Air Quality representative immediately.
19it 44'^:¢:S1i° �"I.1,P- , :ti;{"}•, >�''""�SR'�'"31t,S".k lipii4d$4 ••` e.40Hi5tS$,F%t.tlt?S?};,ia?#aS;;,; -`V'ilfa4[?11X1"t?dri'.n.�i.�S.-i-i..;d..!#.3 s§s.s"a?. - `. �j -.1,i#
Comrnents'(re%r ta►quest,on`#)•E�tplatnany3}YES answers and/or{any reconnmendafions or anyrather;comments �.t�.;;l
g SS" °';zi�;iG#9�'iif<•�i•� „u";G1�ii!L A6€f1h.
tUse drawtngs:of faCllitylt0`better explain situations:(useaddihonalpages;as�necessary): 4�� [�� py ❑ , � `°'.
� geld Co Final Notes � ,I:
kk i r r., : i n ; ?""`- 1_«-- r-�_ --- - w , !w •,�.:
Reviewer/Ins ector Name c '� ;i c t ijj� �y y���� f `Y u a� ,fF c fi�iW;' ^c P�i/� ,ar., J��� .:.,t..._ a►r ,Ga r.r _
Reviewer/Inspector Signature: Date: y-.P- -0
12112103 Continued

r =Facilityber: 0.2 -- / Date of Inspection
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
S-Kb
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
❑ND
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
©-No
❑ Waste Applicatio ❑ Freeboard ❑ Waste Analysts ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R-115
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
&No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
M-No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[9-No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[-JNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[moo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ems
❑ No
3I.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
M-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
OW6-
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
❑-Neer
❑ Stocking For rd;[] Crop Yield Form ❑ Rainfalls❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Farm Name/Owner:
'Mailing Address:
Site Requires Immediate Attention: /V4
Facility No. S Z — / 7Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:.�u `� , 1995
Time: / I : 2-1
CCkNWOL8,'s P3aco►,! % Ckr-eA/Cc, CaNiya
E
NA
County: TO Ma,50 Al
Integrator: a s :i c . Phone: �0 - 5 77
On Site Representati e: eLr-& rce— Ca,J,Ju.d Phone: C9t01 51?Z - 07$$__
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon haye sufficient freeboard of 1 Foot • + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Y e or No
`Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? Yes or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes of l
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oGN
Is animal waste discharged into water of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes ouaN If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Actual Freeboard: 2 Ft. G Inches
Yes or NRWas any erosion observed? Yes o&N
Is the cover crop adequate? Yes or No
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTH CARALIM DEPARTI[MT OF ENVIROMWT, EXALTR' a NATURAL RESOMt(=
DIVISION OF ENMOPI>! WAL MANAGMCMT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
�rypM�W.} :��}N��' ,� (:wn :W^'S'Y}J �ia1f1•Y•,}.�.F•:o:Pi.:.�. •:�T'�9w.fY
fY,J21..�
'Tin:.+-�i
.:J'Y.'" r'��!.: 4Mr/CyM1!91'�i.N.1..� Ate.: n•.?'W •.M++�'T!4: �'M:�S}�M^`.'F`: n::n.:
.µWA.
�
�v.�rrl�/���..ii��+�i.,.�,\��'��E�6•n•r•J���`���/AO���Y.iW>..
r��.iiti9�.�V.�+WF'.:.iyYl
nnnemirlij s ClavenceCunnad
.: �:: •... .w' S " i .Y'. '^' _! .r. rs rH•: }in r'--.. :x^�nr-.��.anf•r�
t ^" %±tii.:`wrr 2 a_ � ?o�.>.wW :w,y>o'.:.... ::vv-s...... +" .
�, .-Li+�•
' yp ��.p��� 1�' F..�NIM+.6',�1
y L�17 r.�\/iLY1.:.7
w+T�� ,;.,
I:\+i.J.�Z ria..C.i[�ViwiY NUMBER <.wf.
.�`�µr`
tN
.�i �.�.i . ,+�:•
t13La S5E ion Z83Z
f 0)
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECPION I
Animal O era on `v vrsffq
Horses, cattle ,awin poultry, or sheep
SECTION I
Y i N I CON ENTS
1. Roes the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (73), swine (250), sheep (1,000),..and
poultry (30,000 birds with liquid waste
systaa) j
2. Does this facility meet criteria for
Animal operation AF.O�nAjX0N?
3. Are animals confined fed or maintained
in this facility for a 12-month period? .
4. Does this facility have a CERT
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. noes this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

ARMOR 1XI
urea
k1eldSite Managmont,
t. to animal va.6W HLUCkpiled or lago=
construction within 100 ft. of a USGS
Nap Blue Line Stream?
x. is animal waste land applied or spray
irrigatcA w4*M n 26 ft. si a UGGO Map
Slue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. noes the land application'sits have a
cover crop in accordance with the
OMTIFICU►TION pLAW
S. is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management practices
(BMP) of the approved CSRTMCATI M?
7. Does animal waste lagoon have sufficient 2
freeboard? Now much? (Approximately � )
9. la the general condition of this WO facility,
including management and operation,
satisfactory?
szengs
Cg-mme'n $
rm 5 -Fo I I o user; 6Y Ce r ii cry o n 5111.01

y � - �� � r': ,', = - n�i. 1 � • �.." �. �rr.r�RTpyrf�
«�1�-.-•lt!!7*r�,'1: _Y'''_.l' ..rL'.1�lff.\i .1�.. t_ .. ., �r�' r�.,'�. `�s,-rill

ANTUAL WIST! HABO03MU= PLAN C3RTI7ICATIOH FOR NSW OR BZ2ANDED FEEDLOTS
Please return the cempletad fora to the Division of Environ=ental Management at
the add. ess as the reverse aide of this fora.
Name of farm Please print) : PREST-A E FARms, Tnc. P-/9b
Address: _A. Q. 80Y. 7LJB ,
C4.147ba /IC zd-2.8 - Phone t3o.:!kto Q92-5771� -
Caunty : SAMRson
Farm location: Latitude and Longittde:J�"�"'/a"(,ez:ired) . Also,
please attach a copy of a county road map with location identified.
T1 pe of operation (swine, layer, dairy, etc.) : h%Wyr E
Design capacity (number of animals) : Deno F Retie! - E n
Average size of operation' (I2 monch population avg.) : 2-000 FAAMOVd- WC4 ry
Average acreage needed for land application of waste (acres):
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Tae-11--ical specialist ca fficatioa
As a technical specialist designated by the North Carolina Soil and water
Conservation Commission pursuant to I5A NCAC 6F .0005, I cer-ify that t^e new or
expanded animal waste management system as installed for the Fars named above
has an animal waste management plan that meets the design, construction,
operation and aaintena,^ce standards and specifications of the :-ivisicn of
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and water Conservation Commission pursuant to 1SA NCAC 2H.0217 and
ISA NCAC 6F .0001-,0005. The following a'levents and their corresponding minimum
criter_a-haAre-been verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party) ; aczess
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwater runoff events less severe'than the 25-year, 24-roux
store.
Name of Teci=ical specialist (PI
Affiliation: ,2k1mr- c FAArn,�
Address (Agency) : A o._ISgA- S;, E
Print) G. Glenn C L I FTan
:zone &Na
Signature:- a• � tom- - _ Date: 5 f /4�zg -
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Owner/Haaager AQseemeat
I (we) understand the operation and :maintenance procedures established in the
approved animal waste management plan for the fans named above and will implement
these procedures. I (we) know that any additional expansion_ to the existing_
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste frcm this system to
surface waters of the state either through a :man-made conveyance or through
runoff from a storm event less severe than the 25-_year, 24-hour storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Name of Load (P se Print) : PPM5'rAGS rA Rrn5 Z., c f1
Signature: Date: s 6�
Name of Han ar, if different from owner (Please print):
Signature: * Date:
*cote: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Enviror-mental Management within 60 days of a title transfer.
DMf USE dNLY:AC.TEW#

Department of Environment,
Health and Natural Resources
Division of Environmental Management
Jcmes B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Ch'R'_=TCA"ON ?CR ME-W Ott ='X?X:*TDt'D AN1M. AID ?='Z=!:S
INSTRUCTICNS FOR CERTIFICATION OF APPROVED ANIMAL WASTE MANAGEMENT PLANS FOR
NFr4 OR EXPANDED ANM.AL WASTE MAtAG=r ": SYSTEMS SERVT-:-G F�DLOTS
In order to be deemed permitted by the Division of Environmental Management
(OEM), the owner of any new or expanded ari^.al waste management system
constructed after January 1, 1994 which is designed to serve greater than or
equal to the animal populations listed below is required to submit a signed
certification form to OEM beio-e the new animals are stocked on the farm.
Pasture operations are exempt from the requirement to be certified.
100 head of cattle
75 horses
250 swine
1,000 sheep
30,000 bi.--ds with a liquid waste system
The certification must be signed by the owner of the feedlot (and manager if
different from the owner) and by any technical specialist designated by the Soil
and Water Conservation Commission pursuant to 15A NCAC 6F .0001-.0005. A
technical specialist must verify by an on -site inspection that all applicable
design and construction standards and specifications are met as installed and
that all applicable operation and maintenance standards and specifications can
be met.
Although the actual number of animals at the facility may vary from time to time,
the design capacity of the waste handling system should be used to determine if
a farm is subject to the certification requirement. For example, if the waste
system for a feedlot is designed to handle 300 hogs but the average population
will be 200 hogs, then the waste management system requires a certification.
This certification is required by regulations governing animal waste management
systems adopted by the Environmental Management C--=ission (E!.!C) on Lecember 10,
1992 (Title 15A NCAC 2H .0217).
C_V1_RTT?T=ATT0N 7ORM
On the reverse side of this page is the certification fo_;a which must be
submitted to OEM before new animals are stocked on the farm. Assistance in
completing the fora can be obtained from one of the local agricultural agencies
such as the soil and water conservation district, the USCA-Soil Conservation
Service, or the N.C. Cooperative Extension Service. The fora should be sent to:
Department of Environment, Health and
Division of Environmental Management
Water Quality Section, Planning Branch
P.O. Box 29535
Raleigh, N.C. 27626-0535
Phone: [phone]
Form ID: ACNEW0194
Natural Resources
Steve W. Tedder, Chief
Water Quality Section
Cate: /1C-
P.O. Box 29535, Rdeigh, North Ccrolir-i 27626-0615 Telephone [phone] FAX [phone]
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Cepa ant el Sav:rcrment, Health and Natural Rescu;cez
Owv sier. o: Zavj_:n;=enzal M_a; aSeme. z
Wata= Quality Secc,cn
w the
aniwal waste management system Or ycu= =eedlcc werat;ca
is
designed tc serve me=e than cr
equal tc ? 00 head
of cat_? e,
K
hoses,
250 swine, WOO OO sheep, cr 30,000 b:rt's =hat
axe served
by
a --n=-
waste system, than this
'==-:must be El__=c
cur and =abed
by Oe_er
e: 31; L993 pu s::an= =
_% NCAC Z .OZ:; (c;
:n crde= c:
be
deemed
a =ivied by CEM. F laa se
__,. ,. cleaVy. .
Far= Name:
mailing Ad ass : Z-F
Ccunz:: ,'A1> ?' 1, -y..- ?hcne SIC
C lv ner (s) Name:
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manager(s) Name:'
Lessee Name:
a Lccac cn (Be as swec' ;' c as CcssibLe : _car' names, diz8ccicn,
smilJeccs , etc. } 1441, AW-j-:/oP ��,�,eL . -�+ /)
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Latitude/Langwtuce if known:
0'r- /S -li? --
Cesign capacity c= a i=a'_ waste management system (Num er-and type
cs cwfinec a.rl.=a= (s)
Average �ai1i�[i=- al pcpulazicn: an t a _arm (Number and type of animal(s)
.raised) •�L.'//..ri�./J �1 w w
Year Prcductzcn Began: A_cs Tract No. -';5]lfl
l
Type of Waste Management System Used:,-
U
Acres Available to Laz ica icn f Wawa:
Owner (s) Sigrac:,._e (s) OA'"r• //93
v OAT
,05 0!