820191_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qud

i ype of visit: seq uompuance Inspection U Vperation Iceview V Structure Evaluation V I echnical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Lf , Arrival Time: (7F o Departure Time: County:
Farm Name: t%rcL�7 Owner Email:
Owner Name: (�e{mac f Phone:
Mailing Address:
Physical Address: /
Facility Contact: �`�� r �"`+ Title: Phone:
Onsite Representative: I t
Certified Operator:
t(
Region v-(�p
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current i
Design Current
Swine
Capacity Pop. Wet Po.pl�try
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
DairyCow
Feeder
Non -La er
Dai Calf
o Finish
G op
F''
DairyHeifer
to Wean
Design
Current
D Cow
to Feeder
�'" D , P,oaltr.
Ca aci
P.o P.
Non -Dui
o Finish
EBous
i
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef BrooTurke
s
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes g44`6­❑ 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
UNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes [:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes TNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: J I Date of Inspection:
WWgste Collection & Treatment
I
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0_1Qa
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NoFT-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
I_J 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
[!]�to
❑ 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
Flo
❑ 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
U lNo
❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [ ' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e54U15
13. Soil Type(s): O 6 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O—No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �IVo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E:fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:rNo
[] NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ffNo
❑ NA
0 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 E]"'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 61No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24� Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-90 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FjXo ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage fond ❑ Other:
❑ Yes ET -No ❑ NA ❑ NE
❑ Yes �' o [] NA ❑ NE
❑ Yes 21—No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
CEI'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
PNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
E No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
k
3. �3
G'I[ u �sl
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
Phone: [(O i 33-3 kJ J K
re: JL^ Date:
21412015

Division of Water Resources
Facility Number C�� - ® Division of Soil and Wate16
Conservation
OO Otlter Agency
Type of Visit: G<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:---f-y County:_
Farm Name: Al "$- Owner Email:
Owner Name: NLGcj to fact,. Phone:
Mailing Address:
Physical Address:
Facility Contact: A)(�i < <-C Title: Phone:
Onsite Representative: `c(Ct!r 5 - Integrator: PV`za
Certified Operator: ( < Certification Number:
Back-up Operator:
Location of Farm:
Wean to Finish
101
ILayer
Wean to Feeder
I
jNon-L;
Feeder to Finish
Farrow to Wean
40 —0--
Farrow to Feeder
Farrow to Finish
GihsBoars
e2DP5
Other
Latitude:
Poults
Discharp-es and Stream Imoacts ``�li
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)?
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Region:IYZ Z)
❑ Yes Eal�o ❑ NA ❑ NE
❑ Yes
❑ No
[�!rNA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR) L Yes ❑ No [._� NA LJ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Eno ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes f7l No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili ky Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No �VA ❑ 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 2'�lo ❑ 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 ['SNo ❑ 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 [nNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [TNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
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 (]j"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): C&Ja
13. Soil Type(s): ALn p 0
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JD'No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
[] NA
❑ NE
acres determination?
t7.
Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
E?(No
[] NA
❑ NE
Required
19.
Records & Documents
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ETNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ 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
dNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and l" Rainfall inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ff No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:rNo
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Ins ection:
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 [ o ❑ 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
✓❑"No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ff"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
dNo
❑ 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
[: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
[�r`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
[allo
❑ NA
❑ NE
Comments (refer to question ff): 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).
Gat, - 5-dZ7-
Reviewer/inspector Name: IJA Phone: Aj-J- 3R4
Reviewer/inspector Signature: ` Date: r 3 t �-7
Page 3 of 3 21412015

L 9 1 N J I A411kA M
Type of Visit: O Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: &Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
��ff�,�
Date of Visit: Arrival Time: ; Departure Time: County: Region:�
Farm Name: (,` I ,� �It✓',rr f Owner Email:
Owner Name: �i(� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: kg Title: Phone:
t f
Onsite Representative: Integrator; *e 7
Certified Operator: Certification Number: J r
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current ;
Capacity Pop.
Design Cnrrent Design
Wet Poultry Capacity Pop. Cattle Capacity
Current
Pop.
Wean to Finish
Laver Dairy Cow
I INon-Layer Dairy Calf
Dairy Heifer
Design Current D Cow
E
D , $oul Ca aciPo 43 Non -Dairy
ILayers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turke Poults Other
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
-
IMIT
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes H'1 o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [7No
[a Yes [-No
ETNA ❑ NE
® NA ❑ NE
["NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412014 Continued

Wacili umber: A jDate of I-
ection:
Waste Collection & Treatment 14
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Er<0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No DIA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):'
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes UK. C] NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify
DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F!J"'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F; o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CA^-7 5
13. Soil Type(s): 0 G a (Zk o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�ro ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [31No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [dNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gErNo
❑ 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 E!fNo
❑ 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 E!r?No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FJ'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412014 Continued

I•
Fatili ' Amber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes EnNo [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [::]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes dNo ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J�J'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ 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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ej No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2fNo
❑ NA
❑ NE
Comments (refer to question f: 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).
IL oj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3 3 D
Date:
21412014

2—
Type of Visit: 0,Com ante Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: l / Fr)f> 1-'i
Departure Time: County: S r V�
Region-PR�
Farm Name:
!y �- jl� L „& : t f
f L'L) y
Owner Email:
Owner Name:
4 j GR -, Lu.lad
Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 t/'L r c. Ly,,e�. c Title: Phone:
Onsite Representative: l l Integrator: P r. t 5 y Q
Certified Operator: Certification Number: A J f r _
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design
Current
Swine
Capacity Pap.
Wet PoWtry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
[ S
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , RoW
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes t o [] NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ff-NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No CNA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [E No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes [3 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'llo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [2-K�V ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�] LJ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3 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
5N
❑ 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
2r o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
El"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E:rNo
❑ 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): LQ
13. Soil Type(s): N b G b ��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ea -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3` qo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑,N-o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E2,N6 -
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑-N-o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Cl"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[I]Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [!j'1VO ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETN_ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:(No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F'aciii Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D'1`io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ©,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ET'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2'1`lo [DNA ❑ NE
Other Issues
28. Did the facility fai I to properly dispose of dead animals with 24 hours and/or document ❑ Yes �No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E 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 [ rNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
Q es
[:]No
❑ NA
❑ NE
�pplication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EjrNo
❑ 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
Callo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pates as necessarv).
cak; br47on "
J
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

s P.0
Type of Visit: (3Comnliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access'.
Date of Visit: g"' Arrival Time: Departure Time: CountycA Regio>�F2n.
Farm Name: �1 E '�!{L { Owner Email:
Owner Name: N Ir ete / i��s - _^ Phone:
Mailing Address:
Physical Address:
L t
Facility Contact: ) Title: Phone:
Onsite Representative: ri Integrator:
Certified Operator: f (�
p � L�Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Cent
uPror
entD-
Swtne-� %VrDegnCPurenfg
Pac
C-WetPoult Ca
SIMON gn
Cattle Ca
acttV
-_ .y p � . Pop.
psaici ty p.
Wean to Finish Layer T_
airy Cow
Wean to Feeder
Non -layer I
a' Calf
Feeder to Finish
..
.r
Dairy Heifer
Farrow to Wean
- DeslgnCgrrent
D ,P■oul Ca ac' ; i'o
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Turkeys
Beef Brood Cow
_
er
TurkeyPoults
Other
F[10:�thher
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes LgXo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [ o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes l g,< [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
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 to
❑ Yes]
ElYes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Q IZ
M -11 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PTNo ❑ 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 Ej 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 ENo ❑ 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 L.IYI` O ❑ Z` A ❑ 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 1_ ,4 ❑ NA ❑ NE
maintenance or improvement?
Waste. Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0�1 o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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): E/1
13. Soil Type(s): fN U r- O 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
Io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yeso
}
❑._NA_
:❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes'
[o
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
;"o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
fi2&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
EJ'No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q4
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

FacilityNumber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!J o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a o [DNA ❑ 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?
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
To
❑ NA
❑ NE
❑ Yes
91, o
❑ NA
❑ NE
❑ Yes
©i'No
❑ NA
❑ NE
❑ Yes ! No ❑ NA ❑ NE
❑ Yes [�Wo ❑ NA ❑ NE
❑ Yes
[E�go
❑ NA
❑ NE
❑ Yes
[! No
❑ NA
❑ NE
❑ Yes
�fo
❑ NA
❑ NE
❑ Yes
I ld, o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers.andlor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
c
Phon j!0—
Reviewer/inspector Signature:
Date: /U-
Page 3 of 3 9 21412011

(Type of Visit: (ErCom 'ance Inspection p Operation Review 0 Structure Evaluation C) Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ZO Departure Time: County: �I
Farm Name: Al Lm x1 Owner Email:
Owner Name: ��1tFi-fityCGS Phone:
Mailing Address:
Physical Address:
Region: -
Facility Contact: <<(,�( f"� ��j(,�tf' Title: J,(I�� Phone:
Onsite Representative: it Integrator: fL-r226e__
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: / S 3 7 7
Longitude:
CPunt
esienSwme CPopu rent
Design Current
Capacy Poultry CDpagty
CaR le
Capacity Pop.
Wean to Finish
Layer
Non La er
Dairy Cow
DairyCalf
Wean to Feeder
Feeder to Finish
_ _
Dairy Heifer
Farrow to Wean
:r
Design Current Dry Cow
Farrow to Feeder
`D : Pout -, `- Ca' aci P,o , Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Farrow to Finish
Gilts
Boars
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes !0 No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:)No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
(—]Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[�To
❑ NA
0 NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Racill Number: 2 — Date of Inspection: 04MOv
Waste Collection & Treatment
eI 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 b
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[fNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes E3"No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
I jl" o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[D15o
❑ 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
[D<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ER o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus [] Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): .r 11 6V 6 V_UL
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
[i]'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[fl—No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff —No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
G'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q*N�_o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [+Yes [:]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking [ ] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E3'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [DN
❑ NA ❑ NE
D Weather Code
❑ Sludge Survey
❑NA ONE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Pacili Number: 21- Date of Ins ectiion: O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [s3 No ❑ NA ❑ NE
i �..,�
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR o ❑ 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 [3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes []'l�fo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ff'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do bsurface tile drains exist at the facility? If yes, check the appropriate box below.
5 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 []?go ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
C3 Yes ❑ No ❑ NA ❑ NE
❑ Yes
[ENo
❑ NA
❑ NE
❑ Yes
[EfNo
❑ NA
❑ NE
❑ Yes
C3 No
[DNA
❑ NE
IComments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary). 1
4isCCR_4;(�&K� y hdi "_C47417 4 6 0 r k
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
At
Phone: 0`q —U3.?f
Date:06� b /�0
21412011

ype u1 v ISIL. %.y l.umpuance inspection v mperauun xevtew 1.1 structure r.vatuanon V t ecnntcai Assistance
Reason for Visit: G-0outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tj ! Arrival Time: '� Departure Time: County: 4,Region: 1"Qlp
Farm Name: [y �� �. uC-A S Owner Email:
Owner Name: N -x C lkX I~. 1A . Phone: CE % I - Ckl o - Ci 3 S- G 3'7
►LAL t►'RRm ►.oc�.��oN) -- j �lst• r.00�s5
Mailing Address: C.GiAp E 15 U1A% E Rower
Physical Address: �Aa 5 oh y _sae. 04 1 F A? Sd n. W C a �� 1
Facility Contact: N = CV+i £ L, ,LA S Title: w KE Phone:
t
Onsite Representative: M L Integrator: �R >✓S�p� 1~
Certified Operator: n]: CK 2 V_' Certification Number: $ 3 SR
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current ' Design Current
Swine Capacity Pop: Wet Poultry Capacity Pop.
Wean to Finish
Design Current
Cattle Capacity Pop.
aLry Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish agkko
C,S S '
Design Current
D Poult F Ca aci P■o P.
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[S No
❑ NA
❑ NE
❑ Yes
2� No
❑ NA
[] NE
Page 1 of 3 21412011 Continued

Facility Number: . - 1R jDate of Inspection: 5 1 la
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 I
Identifier: �ftI
Spillway?:
Designed Freeboard (in): ka
Observed Freeboard (in): 3 LO
Structure 2 Structure 3 Structure 4 Structure 5
6]No ❑NA ❑NE
C]No [g]NA ❑NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
0 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
M 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
[A 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
DNA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[5g 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): �_ 01& P3 X . )'n 9 o►t . SN"L h r Af-,b
13. Soil Type(s): INN D S' , V`bil N 6 R ,._(- n A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Rewired 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 5Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - - Q N jDate of Inspection: 7 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes Q No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus Ioss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
R] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
a] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Signature: Cap
AMN Date: it D:
Page 3 of 3 21412011

i ype or v rsu: w uompttance inspection V uperanon Keview U structure Evatuation V i ecttntcat Assistance I
Reason for Visit. O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Lit / fI Arrival Time: 1 7; 3C A/11 Departure Time: lL°OU Afi Coull iq in15C;'I
Farm Name: tA t N 1, uC A S Owner Email:
Region: F-M)
Owner Name: N:1 C-K 3 Z Ni L jQ A S Phone:
Mailing Address: 11aS G o m n--�Va tlt R(A'7
Physical Address: rA r 5U n t \r— A 3t41 .
Facility Contact: L A 5 Title: () Lj M R Phone: I
Onsite Representative: Integrator: & L59,qc/ E
Certified Operator: N- of xz 1,LkAS Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
_- - -
Design
Current
Design Current
111 Jill
Swine Capacity Pop.
'VVeti oultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder gt4O
I INon-Layer
Dairy Calf
Feeder to Finish tx=-kx;;D 14-1
b
Dairy Heifer
Farrow to Wean
Desigrr
Current
Dry Cow
Farrow to Feeder
©rylPo°ul
Ca acity
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
..
Discharp_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes N No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes [:]No
❑ Yes
[] No
❑ Yes]
No
❑ Yes
[� No
g] NA ❑ NE
5� NA ❑ NE
(] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
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): Ici
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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes t 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
c
12. Crop Type(s): COCkNt L.�+'tt�,a . So,i be AA;
13. Soil Type(s)= %1() (�)1 Fi:P _ Nil A. R A I C_'(} rl - - —
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes a] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ Wi.1P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: jDate of Inspection: 1117 361
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 Z] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0(] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No D NA [] NE
D Yes 0 No ❑ NA ❑ NE
❑ Yes [X] No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[4] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
IX rV&.wa.,11113F�a LWJ 1Vit11lG. >,lSl..1 �Y - n+ •,s�•M r rpivur.
Reviewer/Inspector Signature: C� Date: /! 1 1
Page 3 of 3 21412011

Type of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L2D/4_�Arrival Time: '. DO Departure Time: County: A-- Region:
01
Farm Name: _tam'- �l� _ --tx 1C 5 _ Owner Email:
Owner Name: A f C TL Iv L_" r_ a.t Phone!
Mailing Address:
Physical Address:
Facility Contact: _ /� �GFc - /-t._ed.5 Title Phone No:
Onsite Representative: S'-� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = = « Longitude: = ° = I ❑
Design
Current DesigA Current
ion Wet Poultry C+apacity Population
Cattle
Design ntjM
Capacity PopulationFinish
M
❑ La er
aow
Feeder
❑
❑ Da Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
�E]Gilts
Boars
t7
3 a0
-Non-Layer
Dry Poultry
❑ Layers
Non -La ers
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Pullets
❑ Turkeys
❑Beef Brood Cow
Number of Structures:
Other.
❑ Other
❑ Tur ey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 ELNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PAVo
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
Page I of 3 12128104 Continued

�J
Facility Number: Date of Inspection b
Waste Collection`& Treatment
4- Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 3,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
%No
❑ NA ❑ NE
Ge/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
CEkNo
❑ 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
5 'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
54 No
ElNA [INE
(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
91 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
CR�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
MNo
❑ 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 Acceptabie Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) AL9jT1zL0,4/ j ZDZ / Rel- e�syf�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
[2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR NNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendationsorany other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I Phone: %­ZI.T ��300
Reviewer/Inspector Signature: Date: _ �1_14- ®ZodD
Page 2 of I21261W c,ontinuea

r
r
Facility Number: } Date of Inspection Q
= Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J4 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
[&No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
4No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
]4No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C.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
2 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
5& No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
El NA
El NE
Additional Commeits,andlorDrawings:• .
Page 3 of 3 12128104

L
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0<outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: — n 7� Arrival Time: 1G0 Departure Time:So o� County: Region: F Q
Farm Name: rfjd-- — U e, rx < _ Owner Email:
Owner Name: 'I c, �_I N L' e cxPhone:
Mailing Address:
Physical Address:
Facility Contact: _N c- L, u Ga. S Title: _ itnYt- Phone No:
Onsite Representative: Integrator: a
Certified Operator:Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = g =Ig Longitude: = o = t 0
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Popula#ion
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish 141 Q A2
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Gilts ❑Non -La ers
❑ Pullets
❑ Boars
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non
-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes QNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes No El NA [I 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): 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[9No
❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[,No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
ir,R'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
1�1 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
1KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes
SNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
nNo
❑ 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) �r�fs-r ��Jii�-.t.i` �3�9 -i��a• -4
13.
Soil type(s) %U O D
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D9 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any -"recommendations or.any otherscomments ,.
Use drawings of:facility to better explain situations. (use additional pages -,as necessary)
AL
Reviewer/Inspector Name
Phone: /p—t �-t 330 o
Reviewer/inspector Signature:
Date: a
1/ 12/281Y4 Continued

Facility Number: Date of Inspection�—
Required Records & Documents
' 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes GLNo ❑ 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
[RNo
❑ 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
❑ NA
❑ 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
[A No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5a No
❑ 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
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EANo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
12128104

Type of Visit 0<0-mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: D {7 Departure Time: % > County: Region:
Farm Name: _ �, #d- E! U aa-3 Owner Email:
1V Owner Name: _ ; e- k, i r 0 __L Lc L er ,S Phone:
Mailing Address:
Physical Address:
Facility Contact: ? L ` e U Title: Phone No: t� � T%�`3
GAY
Onsite Representative: . .5 � Integrator: / 2;�:a
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: F-1 e E T ET Longitude: [� o [�j F
_,-
--
�Desrgn� Current
Desin Cu err errntultry,C
Design Current
SwineM0sg0ryl
pulatton Wet�P,o p city Population
Pk..
Cattle LL L Capacity Population
o Finish
❑ Layer ❑ Dairy Cow
to Feeder
❑ Non -La er DairyCalf
.�►r
DairyHeifer
❑ D Cow
D Poultry
<... .. - ElNon-Dairy
El
Farrow to Finish
�❑ w
El Beef Stocker
ElNon-La ers "`
El Beef Feeder
❑ Pullets ❑ Beef Brood Co
Turkeys ,�. � �::• � ...
Other -�' ❑
r} 7 : ti
TurkeyPoints
❑ Other ` [] Other Number of Structures
❑ Wean t
❑ Wean
eeder to Finish O
❑ Farrow to Wean
El Farrow to Feeder
La
❑ Gilts
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
IV No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
®, No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[3 Yes
9LNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facilih' Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RLNo ❑ 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): r�J`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1K 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
R 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
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
1R No
❑ NA [:1 NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
g] No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) fV 0 ja !._ _ FbA /)U D A
W.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P9 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
V No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ NA
❑ NE
Reviewer/inspector Name �+ �_ � � Phone:
Reviewer/Inspector Signature: Date: t]�
rage z of J 1 ZlYaVU4 Continued

Facility Number: — 1911 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes E,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jallo ❑ 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 E,No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EINo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[RNo
[DNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ER�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
UR:No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CgNo
❑ 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
V) 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
J.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
[RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
14 No
❑ NA
❑ NE
Page 3 of 3 12128104

f
it
rvision of Water Quality '
Facility Number Q Division of Soil and Water Conservation %
- 0 Other Agency
Type of Visit Compliance 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: f D County: Region:
Farm Name: ou tt N Lam, U C,2_4 __ _ Owner Email:
Owner Name: Phone:
Mailing Address: % � / J�(`p (.t l f? � 2 pr / dz i 5'a Al C 4292-4Z
Physical Address:
Facility Contact: + G �' e_— L htC o S Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =' [::] " Longitude: 0 ° = ' =_
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
ry�� _ ❑ Non -Layer
Dry Poultry
Layers_
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
acts
I . 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 I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 QNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
12128104 Continued

r
r
Facility Number: 42—
Date of Inspection d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No ❑ 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): 19
Observed Freeboard (in): `l to
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
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
R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
kdNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
9f No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
LffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1Z 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
i9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
PSNo
❑ NA
❑ NE
f Comments (refer to question ff): Explain any YES answers and/or any recommendations or any other comments. I
}f Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name S G- ,v �� Phone:
Reviewer/Inspector Signature: Date:
■Zi_1aiv1# "nunueu

Facility Number: Date of Inspection E7
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 19 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
(R No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CH No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
XNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
5a 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
5dNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

�r
Type of Visit 0—Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint. 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: ; Q Departure Time: CountyRegion:
Farm Name: kj a C. iz Owner Email:
Owner Name: �-% / C. t "a• L u e at—s Phone:
Mailing Address: 16 e_1 Wp/ d r Fa ; Ste",- ]" e • _ 6
Physical Address:
Facility Contact: _ 4 r u C Q Title:
Onsite Representative:
Certified Operator: -�—
Back-up Operator:
Phone No:
Integrator: 0�.__
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 4 =if Longitude: = e 0 A = «
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ an to Feeder
I ILI Non -Layer
❑ Dairy Calf
Feeder to Finish qo
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ T urkey Puults
JE1 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[Q No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
9[No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ZNo
❑ NA
❑ NE
other than from a discharge?
Page I of
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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): y7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IQ 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 [0 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 (9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �'No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LdNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) Z��
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
® 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
[9 No
❑ NA
❑ NE
Reviewer/Inspector Name �,��� y °1r' .: Phone:
Reviewer/Inspector Signature: Date: (oC�Co
1rL1L61V4 9.onnnueu

i
Facility Number: - Date of Inspection
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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 14 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 21 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
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J0 No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L9 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
J4 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
[� No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
14 No
❑ NA ❑ NE
Page 3 of 3 12128104

.;. Division of WaterQualit}:
Eactlety N
J um�ier f q O Division of Siiil and Wetter Conservattot�
0 OtherAgenc}� t '
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: eZ: oo Departure Time: E== County: Region: F90
i
Farm Name: N . N aka. Owner Email:
Owner Name: _ N l a k' Fi l v i- -23 17
-�.[�s�w� Phone: ce_S( 2 4_ —
Mailing Address: &57 G rn &, a� RQQ * eLi S&Aj N c eRR3Yl
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: &%eE / At y_,ks. r-
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number: •, _12312
Back-up Certification Number:
Latitude: = o ❑ ' = Longitude: El a ❑ = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish1a?.qLjj>
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkevs
❑ urkey Poults
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ElOther
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood CoYA
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 [A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
Cl NE
❑ Yes
DMNo
❑ NA
❑ NE
12128104 Continued

Facility Number: ?oZ — J 41 Date of Inspection 6 g
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [A 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): a'1.�. G ~ I b /v y/93
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ® 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 R No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [4 No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ® 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
{N No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12.
Crop type(s) C* 0­3 Lo%3 {, a b L
13.
/+XS
Soiltype(s) �/o,U . iq
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�fl No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? N ❑ Yes
50 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
f�gl No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[A No
❑ NA ❑ NE
Reviewer/Inspector Name 'qa � '/, Phone
.c ;.
Reviewer/Inspector Signature: Date: G - —
711rs0mi-- -----�

Facility Number: 8cZ —19 Date of Inspection 6 V-4-�
RecLuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the propriate box below. ❑ Yes [A No ❑ NA El NE
J. Ai, �$
❑ 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
® No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
5 No
❑ NA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
El Yes WNo El NA El NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes 11 No ❑ NA ❑ NE
❑ Yes
[10 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104

Type of Visit ! Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: ` i7 Time: g'• i 9
0 Not Operational Q Below Threshold
El-Flermitted EJ eertified 1/Conditionallly Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ------ .. _ .............. County:
Owner Name: N c 1 cas Phone No: *0 - � 6 7
--------,.,............. ...................................................................... .......... —. ............ , [. �. - - Mailing Address: ...r7J._..... Y?°4+ C'f......... ...5N� �1 3L
Facilitv Contact: --_ Ali (IL.-----.__. L ............ _...._-Title: ..... Phone No: r%L�w �G 3__. ].3/'7
Onsite Representative: N �' c. ��',w..__L �'Ca�_.. „__ ._ ........._._._._.._...._..... Integrator. ,,..1 LC 'Q ap ._ — ------
Certified Operator: Jul it...li(1�......._.0 v 4fa
Location of Farm:
Operator Certification Number:
E319wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 49 Longitude • 4 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑-PPo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑-No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes PNo
c. If discharge is observed, what is the estimated flow in gai/min? —�-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes &Ko
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ekfio
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes e-go
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes U'110
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -- - _ .. - .......-----•.................. - •- •-.
Freeboard (inches): D
.12112103 Continued

Facility Number:,q Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ YeS
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 maintenanceltmprovement? ❑ Yes aK&
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KKo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes E],No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
P-i<fo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
EKo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Cora La'u s , w4iraT-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNT)?
❑ Yes
91<o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
EWo'
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
MXT'
15. Does the receiving crop need improvement?
❑ Yes
❑l!o
16. Is there a lack of adequate waste application equipment?
❑ Yes
M Mo-
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation? �
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 91 o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Rio
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 Qlqo—
Air Quality representative immediately.
Camnieuls (rues to�gnest,on #) Ezpla>in any YESYaaswe[s and/or any recynanueudattonrs or any other sommeats Y� ;
,Use drams of iaceLty to better ex�laia szotts(use too al pages as necessary) Qfi�e1d Copy ❑ F nal Note a
_._�. ,,�s .....-„- d.,� v...---��:..:..y �.r_-.. .,_ .a ._. !:�- ...;:'r....'a.�. � 1:...._...._:_ a'° -? �r�� ...._ _. �'a'#„rw�,T �"-' `.r�.�-� -, �.. _. __.__._.. _��w_ .w��,a.-F ..�-nx.-�.
rprrn 444
/-,--Of- rri , S y/e // /lejo 7`
Reviewer/Inspector Name
Reviewer/Inspector Signature J?j� �, - Date: t-/ '�V-o y
!1✓��ivs Continued

Facility Number: —I cf I I Date of Inspection 1 C
Renuired Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, reaps, etc.)
23. Does record keeping need improvement If yes, check the ap ropnate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysi❑ Soil Sampling✓
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewfrnspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Fo ❑ Crop Yield Forst' ❑ Rainfall ❑ Inspection After I" Raiff
❑ 120 Minute Inspections ❑ Annual Certification For<rr--�'
❑ Yes 931�o
❑ Yes @WQ
❑ Yes ❑-No
❑ Yes E3-N6
❑ Yes EkNo
❑ Yes E rNo
❑ Yes 9-f4o
❑ Yes Q"No
❑ Yes Ergo
931es ❑ No
❑ Yes ❑"90-
❑ Yes ❑-Ko
❑ Yes E�N—o
❑ Yes LWb
❑ Yes RVo
12112103

Site Requires Immediate Attention: _ A) c,
• Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT Sig"
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 22IR 1995
Time: 1 2 I c7
Farm Name/Owner: rf r daIfr rltr els/ qJ Z lu L ti c as
Mailing Address:- t z T v N
County: S o mj2sr^ -
Integrator: V7 -5 _ � Phone:
On Site Representative: 2a. _ r t < < K �� �, =—a _ Phone:
Physical Address/Location: _ tics R _ I a z s, _ _ _ •- _ _ - - -
Type of Operation: Swine Poultry Cattle
Design Capacity: 3,o -c LLS_ Number of Animals on Site: _ '-lop '7 3
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (�r No Actual Freeboard:_-2,Ft. _( Inches
Was any seepage observed from the lagoon(s)? Yes oKj;� Was any erosion observed? Yes or(Q
Is adequate land available for spray? 63� or No Is the cover crop adequate? �or No
Crop(s) being utilized: ir a�q C fa n UJ yCt
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells?da or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or <10
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 10 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)? ee r No
Additional Comments: w P P M7:,At/, �J Y7e" ."O > 4 �
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

NORTH CAROLnM DBPART![ENT OF ZNVnWMCMT, BSALTH b NATURAL RESOM CES
DIVISION OF EN MOrII�+iTAL
Fayetteville Regional Office
AniMnl Operatfca Compliance Inspection Form
1-h)rn IN i V_ rLLCoc,
s.. � . k - Nf�.+-m7-_1�D�. a". � ; «E r:ar�"3��`,� •.�!�^ w x�,i.t�'"C.^.e.`� 1i�..1L1S S '..Qa�Is .��� +:�'
All questions answered negatively will be discussed in sufficient detail in
the -Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal aeration e: on; shing
Horses, cattle, wine poultry, or sheep
SECTION Ii
Y I N I COMMENTS
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
systam) j
2. Does this facility meet criteria for
Animal operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIM ANIMAL
WASTE MAKAG22MM PLAID?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
G. Does this facility meet the 5CS minimum
setback criteria for neighboring houses,
wells, etc?

s�crlap zYI
Fjg1d Site management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Lime Stream?
1. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordance'with the
CERTIFICATION FLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
5. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved MTTFICATION?
7_ Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
8. Is the general condition of this CAFQ facility,
including management and operation,
satisfactory?
SECTiCN IV
Comments
t

1

?=G!S7TA ::N FORM =CR ANIMAL -__-,rn'_" 01EFAMN5
Depa:�ent of Sn virorme_^-t, health and�Natu-a_ Resources
Division of L vironmental Management
Water Quality Section
if the animal waste :management system for yow feedlot operation
is
designed to serve ;tare =_:an cr
equal to NO head
of cattle,
75
horses, 230 swine, ? , J00 sheep, or 30,000 birds t`at
are served
by
a liquid waste system, then =his
=crmmust !:e f__ied
cut and mailed
by December 31; :993 pursuant _..
_=A NCAC 2 .02,7 (c)
_n order to
be
deemed permitted by DEM. Please
print clearly.
l
Sa_m Name: %�� e)y k C,e+—,Z --
Hailing Address:
Ccunz .
Manager (s) Name:
Lessee Name:
Farm Location (Be
.ii, eccst, e__ ) .
_!gone No. Q?0" ai n I
as specific/as possible: road names, �jdi_ection,
- 0 ^ "1 ( f � ,. � r. � -1 .0
1-
r 0-
J-P_at_ ude/ ongiz de known: !(,' i�, - l.S-J30-J-�- f
Design capacity of animal Waste management system (Nurtcer and type
cf ccrfined anima! (s) ) ,-Sq'10
Average animal population- cn the farm (Number and type of ani=al(s)
raised) .C�m At A C,),!r
Year Production Segan : L9 2 2_ ASCS Tract No.: ---
jr
Type of Waste Management System Used:
Acres Available for Land ppl_catlo of Waste:
Owner (s) Signat_re (s) .
DAr'

�' � �
—��� —.
�{. � ■
�ai�r�'6 �+F)

€ .-- _
-; _ .; ; .
.. _'�y: Z_ :�. _.
1w
' •-.
:,:;,.-�
'�J :. �'�