820334_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: O—Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: &I routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; Oc7 Departure Time: County:��i�'^-- Region:D
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: jrJa•i ;?ra-r.3a----- Title: 19 cLyt ro- Phone:
Onsite Representative:
..57-M-9-p-
Certified Operator:
Integrator: Az����
or
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C•urreut.
Design
Current
Design Current
Swine Capacity Pop.
Wet Poaitry
Capacity
Pop.
Cattle Capacity R.
Wean to Finish
Layer
DairyCow
Wean to Feeder
3
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Ptoult ,
Ca ci
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Puults
Other
Other
Discharges and Stream Imoacts
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[2<o
❑ Yes
G3 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2r 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):ti�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E31�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 [3<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q, o ❑ 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 [] N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Ea<o 0 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): `X�r,.#m4Cdl _
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EJ'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
[3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ ' o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
�iNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ f No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] No
❑ 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 ET'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 01�40
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: r2z- ,�I Date of Ins ection: f-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L3 tVo ❑ 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 eNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE
Other Issues ,-�,�
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ICJ 1VO ❑ 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 ETNo ❑ 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
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 reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes QNo ❑ NA ❑ NE
0 Yes l211U ❑ NA ❑ NE
❑ Yes Flo
❑ Yes iVo
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
CommentsUse drawings of facitity o better ixplain.sifuations (u a additional- ay es as neces $ ommenaahons or any other co nvents.° r
( ) P. Y:
P 1;
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: ompliance 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 0 Denied Access
Date of Visit: Arrival Time: ; O' Depa rtu re Time: County: Region:}
Farm Name: r1 C J �XJU "'y=r' `ram Owner Email:
Owner Name:f Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: egM,1 7 Phone:
Onsite Representative:-�-
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
]integrator: Xrz
Certification Number:
Certification Number:
Longitude:
Design C►arrant Design Fcurrent Design Curren#
Swine
Capacity Pop. Wet Poultry CapaciPop. Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
1-9
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
' Design CnrMen# Dry Cow
Farrow to Feeder
DP.oult . Ca aci Po Non -Dairy
Layers ers Beef Stocker
Farrow to Finish
Gists
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
r
Other
Turkey Poults
Other
Other
Dischar2es 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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ANo
❑ Yes ®, No
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

` Facility Number: -tfDate of inspection:
Waste Collection & Treatment
y�
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): /91—
Observed Freeboard (in): '-';z e
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
jj�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
R,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
UL No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ffjNo
❑ 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
2jNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): A u
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff3 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 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [Q 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 El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Outer:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes fallo
❑ 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 f No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Eg-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 3 Date of Inspection: /
1 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z 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
EKLNo
❑ 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 pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:fV
Date: 1� r/ %— 70/,
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 40 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: JJ e� Arrival Time: a Departure Time: OnODa County: 'T Region: F49
Farm Name: 4-1 f orien PS Owner Email:
Owner Name: Mark ka So yt Phone:
Mailing Address: ?06 4%%ji►k 1 _.'4/'C rICi�'lT�ilrl�n v�
Physical Address:
Facility Contact: 147Aek AarJoh Title: noy a Phone:
Onsite Representative: Plark 4'aarso h _ Integrator: /Pres7Sc4P.
Certified Operator: tct rq e✓ _ Certification Number: f✓ i���
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Desigp Current
Design Current
Swine
Capacity _, Pap. �Ve# PpWtry Capacity Pop.
Cate Capacity PoF.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
can to Feeder
1
1 Non -Layer I
Feeder to Finish
- ''
Dairy Heifer
Farrow to Wean
Design Current
Il . ,il?oul Ca aci P.o .
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
tither
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[✓ No
❑ NA
❑ NE
[:]Yes
[ No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number; 35N - n33, jDate of Inspection:_ 1(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3,3
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 [V3 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 [Llo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [21�o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [-]Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [N0 o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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): J! t rmud ra loverjee?J
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E f No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ["No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[]Yes VNo ❑NA ❑NE
❑ Yes [2No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ 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 21N' o
❑ 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 ZNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
[DNA ❑NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
[✓]DNA ❑ NE
Page 2 of 3 21412O15 Continued

Facili Number: - Date of Inspection - it7tho
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes E No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �io
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 E2r'N o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
ReviewerAnspector Signatui
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes D" o ❑ NA ❑ NE
[:]Yes [/No ❑ NA ❑ NE
[:]Yes [No ❑ NA ❑ NE
❑ Yes 63No [DNA ❑ NE
❑ Yes Z-No
❑ Yes [XNo
❑ Yes [✓? No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: _ f Z _1 f
214a l 5

hype of Visit: (cMompliance Inspection V Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , �; O Departure Time: ! p County: BZ— Region:
Farm Name: r— r7 CS Owner Email: -- —
Owner Name: 1 A Phone:
Mailing Address:
Physical Address: G
Facility Contact: lS8 Title: 1�hY+�`r Phone:
Onsite Representative: ! SIntegrator:
Certified Operator: J�� - Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current_
Design
Current
Design current
Swine
Capacity
Pop.
Wet Poultry
Capacity.
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
n-La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oultr
Ca aci
P,o
Non-D '
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Other
T ey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes J�jNo [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

- Facility Number: A7 - Date of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
:Z No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J. 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
❑ NA
❑ NE
waste management or closure plan?
'�JNo
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
5jNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Jallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes Jallo ❑ 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): �t`//77i1 �Qvr/�zrYtl
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes Cig-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?
Renuired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
.2-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
Jallo
❑ 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
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

" Facility Number: - Date of Inspection: /S
' 24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo ❑ 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 10 No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Co No ❑ NA ❑ NE
[:]Yes JZNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[B No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
jo No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Lg-No
❑ NA
❑ NE
lComments (refer to question ) Explain:y y additional recommendations or:y other"comments:' `�
Use drawings of facility to better eaplsituations {u a addition! pages, as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: ZX0
Date:
21412014
Page 3 of 3

Type of Visit: om nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p-/ Arrival Time: Departure Time: D County: Region: rxlv
Farm Name: .1 Lt. Owner Email: --
Owner Name: >'7 W'a"h %�ar.3r­ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Ma"/.c Title: _&/in rf Phone:
Onsite Representative: .5 a--<— Integrator:
.01
T
Certified Operator: fog { Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current Design Curren# DesigrilLowpiTent
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
INon-La er
I
I Dairy Calf
Feeder to Finish
, :.::
D . P.oul Ca aci Pao
ILayers I
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finis
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
jBeef Brood Cow
QtherA.
691Turkey
Turkeys
Poults
OtherI
Other
Discharges and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
[:]Yes
�dLNo
❑ NA
❑ NE
❑ Yes
2q-No
[DNA
❑ NE
Page I of 3
21412014 Continued

Facili Number: - Date of Inspection: ~� Q
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): z
Observed Freeboard (in): 1`7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Pj No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ 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
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Pg 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): l B_vc.f�rt0 _
13. Soil Type(s): 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M 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 f@ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[S No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
S No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J�jNo
❑ NA
❑ NE
the appropriate box.
❑WLJP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes S No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes JA No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faciii 1Vumber: - ITY I I Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ®.No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes No
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[:)Yes [.No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes JRNo
❑ Yes 54 No
❑ Yes 15.No
❑ NA ❑ NE
❑ NA ❑ NE
0 NA ❑ NE
Com ents. (refer to Use drawings of qnestion #):-Explain,any YES answers and/or
better a lain situations use dditional9 d
a e a recommendations
necessary)ar F
anyother comments.
�iK %�YC:t�/t►5 (�/��� iry : t'[.c/re� ll~-�--- 1 � 1 �"' %=J
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

ivision of water Quality s�
Facility NumbeDivision of Soil and Water Conservation
© Other Agency
Type of visit: ompliance 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 0 Denied Access
Date of Visit: 1 Arrival Time: C7 Departure Time: �, County: Region: r?�a
Farm Name: T(f 'T fI"J u r,$ e/- r I'S Owner Email:
Owner Name: 17L Aly.,.,A fi wZZTVZ ..- Phone:
Mailing Address:
Physical Address:
Facility Contact: eZfal-A J�ra���`� _ Title: 4Vwh r-l-
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Gurrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
I.Dairy Cow
Wean to Feeder
�'
Non -La er
IDairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oWt .
Ca aci
P,o P.
Non -Dal
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
rl—Beef
Brood Cow
keys
Othe
urkey Poults
Other
Other
Discharces and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes EL No
E] Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

' Facility Number: - 0 2 411 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):�
Observed Freeboard (in):
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
R! 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
[2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): %&r e
13. Soil Type(s): f V • ._
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 2 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
[K No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LK 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 [Z 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: - 33 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No
I
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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Callo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z 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 conccm?
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 CA WMP?
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 0 No ❑ NA ❑ NE
Yes CgNo ❑ NA ❑ NE
❑ Yes ,® No ❑ NA ❑ NE
[:]Yes
®, No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[:]Yes
[.No
❑ NA
❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or any other cornrnents.�_� .
Use drawings of facility to better explain situations (use additional pages as necessary). -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Dater
21412011

Type of visit: om ance Inspection Operation Review O Structure Evaluation Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; Q Departure Time: pu County: _ Region: F9<b
Farm Name: (T 1 �j V! , 5 i YS __- Owner Email:
Owner Name: %j A6 Per.S'p Phone:
Mailing Address:
Physical Address:
Facility Contact: IXA%'I< ��.r cam.. Title: e9ufrt Y f Phone:
Onsite Representative: gg-,ze,— Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
orLl`�'Ca aci ' Po
-
���SwMe-
_ -
Wet Po I I Design Current
gltry Cap ty Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D , P,oult .
Ca aci P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Beef Feeder
lBeef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Dischar 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)?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? C] Yes ®, No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Lg-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facifi lumber: rZ - Date of Ins ection: 7 '�
Waste Collection & Treatment
of 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): ,:;�2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E§ 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
MNo
❑ 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
[B 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): �el,ML()0- / ) a
13_ Soil Type(s): 4 &(
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes S 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?
Required Records & Documents
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes EE[No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
6a No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
allo
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
El No
❑ NA ❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
fZ No
[] NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (2 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D4,No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
MNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Eg No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other=
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes [gNo ❑NA ❑NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes 2] No ❑ NA ❑ NE
❑ Yes ©No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explatrrany YES answers and/or any additional, recommendations or any, other conitnenfs.
Use drawings of facility to better ezplain:situations (use addittonat pages as necessary): - _:, ..�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /
2/4/20I I

I
Type of Visit: (9'Coroutine
•nce Inspection () Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 105i� Arrival Time: ; DU Departure Time: D County: ` Region
Farm Name: ( /je, Ste/ I C —5 Owner Email:
Owner Name: /'r , i%1Q,.-k Phone:
Mailing Address:
Physical Address:
Facility Contact: a ao.%- Title: Phone:
Onsite Representative: SIntegrator:Ar
�•
Certified Operator: ����_ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wef Poultry
3
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder j1p Q ap
Non -Layer
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Y,. �,.
Design
Current
Dry Cow
Farrow to Feeder
D Poult ,
Ca aci
1?0^.
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 Impact
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [:]NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes IF-4 No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes U No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - ,g Date of Inspection: f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(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 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ONE
❑ 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): -T k U C e_ 2_
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 ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M 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 JANo ❑ NA ❑ NE
❑ Yes 2 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 C] 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1�3 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2S 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 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes [N No ❑ NA ❑ NE
[:]Yes Uj No ❑ NA ❑ NE
❑ Yes
M, No
❑ NA
❑ NE
❑ Yes
g. No
❑ NA
❑ NE
[:]Yes
® No
❑ NA
❑ NE
Comments (refer to question #) `�Expl.am any YES answers and/or any additional: recommendations or.Aany"other cainments: q
-:,�; . ..
Use drawin-s of facshty to better, explain'situations`(use additional pages as necessary). �"w tee,_
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone:
Date:
21412011

1.1
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: VDU County: Region:
Farm Name: d r7L- 7— A4(Owner Email:
Owner Name: "!t — ��Q/`3B `--� _ Phone:
Mailing Address:
Physical Address: Facility Contact: 1&.04 '�'�'� __ Title: fiJr1 Y�� Phone No:
Onsite Representative: ,S'�-�— integrator:,E__
.611
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 = =66 Longitude: E=l o 0
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design C►urgent
Cattle Capacity P©pulation
Vanto Finish
❑ La er
❑ Dai Cow
an to Feeder
'�
❑Non -Layer
[I Dairy Calf
❑ Feeder to Finish I
I
Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Layers
on -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Da Cow
ElNon-Dairy
El Beef Stocker
ElBeef Feeder
❑ Beef Brood Co
Number of Structures:
El Farrow to Finish
Gilts
EBoars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L!�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
C6 No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number:
Date of Inspection/40
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑Yes 99No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ERNo ❑ 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 CffNo ❑ NA ❑ NE
8. Do any of the stuctures tack adequate markers as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V1 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN '> 10%or I01bs ❑ 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) ,� jam, a. Zia— '=r�
13. Soil type(s) AM,
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes EjNo ❑ 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 JZ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes A No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes NSNo ❑ NA ❑ NE
Reviewer/Inspector Name
Phone:-- �O
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection % / p
_i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VSNo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ER -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Eallo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
K[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
allo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
[I NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;ffNo
❑ NA
❑ NE
Addi6dnal Commeitits andoo Drawin s '`'°"
r
Page 3 of 3 12128104

Type of Visit (Dr —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: ~r D'-i7 Arrival Time: Departure Time, County: - 7 Region:
Or
Farm Name: !I ri T !J u r s e f r +: Sri _ Owner Email:
Owner Name: /Yl / �' T �[i rS ��-� _ Phone:
Mailing Address:
Physical Address: Q
Facility Contact: � e8 ! ina r's� _ _ Title: Phone No:
Onsite Representative:-19-.10.
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = i 0u. Longitude: = o =' = "
Design current
�__Gtrrent
Design Curren
Swine Capacity Populafion
Vet Poultry apacity opulation
Cai#le Capacity Popnlation
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder
(PD 8D
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Nan -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
DZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5d No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

4
t. Facility Number; Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes f KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Stnicture l Stnicture 2 Structure 3 Stnicture 4
Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes C9 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 S 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? JKYes *ro ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes NNo ❑ 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 ��dd
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V4No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
D4No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
K 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
KNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
cat -gnu w ask;
Reviewer/inspector Name Phone: W o—1 f3_ J-230o
Reviewer/Inspector Signature: Date: IZ1 n — p 9
lZr28104 Continued

j Facility Number: XXDate of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
❑ Yes ® No ❑ NA ❑ NE
❑ Yes t0 No ❑ NA ❑ NE
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 V 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?
❑Yes
®No
El NA
❑NE
❑Yes
®No
El NA
❑NE
El Yes
0No
El NA
El NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑Yes 5No El NA ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes qNo ❑NA ONE
❑ Yes J4 No ❑ NA ❑ NE
❑Yes 10No ❑NA El NE
12128104

4
Type of Visit (r"Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I 7__', 30 Departure Time: �Con nty: Region:/_)�' Q
Farm Name: � _ AluC.<if 1Owner Email:
Owner Name: _/y' A/a "A 1�'i7/'Lr Phone:
Mailing Address:
Physical Address:
Facility Contact: &Lb/' >� �1�itr S� �� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 4__i fz�
.01
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = f = Longitude: = o = , = u
Design Current :.13113 ign Current
Design Current
Swine
Capacity Population Wet P,_oultry : C" acity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
a
1]
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry a
�..
❑ La ers
❑ Dairy Heifer
El Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
IN ❑ Pullets
❑ Turkeys
❑ Beef Brood CnuA
❑ TurkeyPoults
❑Other
1=,° El
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ 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? (Il'yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
DiNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
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 J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(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 EX No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
� No
El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
101No
El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
QNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ T'otal Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) annr" �OTi e/ScYdl
13. Soil type(s) l'V V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[A 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
[I No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
%No
❑ NA ❑ NE
Reviewer/Inspector Name I $ Phone:
Reviewer/Inspector Signature: Date: r>
rage _- of s IfZi.coiUlf i'lidnuer�

• Facility Number: — Date of Inspection
t Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box.
❑ WIIP ❑Checklists El Design El Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[-No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively_certified operator in charge?
❑ Yes
ERNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ER No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[4 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
EN 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
ANo
❑ 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
[ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fR No
❑ NA
❑ NE
Additional Comments and/or Draivutgs zft
"d
:.
Hv
Page 3 of 3 12128104

0 Division of Water Quality %r %
Facility Number �' 0 Division of Soil and Water Conservation D �— a
- 0 Other Agency
Type of Visit 0 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: 1 •j?7 -07Arrival Time: ; Departure Time: 'p0 County: Region: V'
Farm Name: {/ dt 7 N , r'S er t 5r� Owner Email:
�1
Owner Name: / � • ge A / ��rS D-"`� Phone:
Mailing Address:
Physical Address: 1�
Facility Contact: er � 7r--4/"S V-- Title:
Onsite Representative: .3 �-e--
Certified Operator: S'02=r'
Back-up Operator:
Phone No:
integrator t
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 , = Li Longitude: = 0 01 =
gg
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer_
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poulin
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
E]Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility dumber: — Date of Inspection — 0-2
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):
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JM 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
KNo
❑ 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
1A No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
®.No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C.No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) -m"
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Lallo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector (Same Phone: 3
Reviewer/Inspector Signature: Date: ZZ2= 0 QD
12128104 Continued

Facility Number: — 3,3 Date of Inspection Eo _y — 2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5d No ❑ NA ❑ NE
the appropirate box. ❑ )XrUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �3 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or
❑ Yes
LgNo
❑ NA
❑ NE
❑ Yes
EtNo
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
52 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
K1 No
❑ NA
❑ NE
❑ Yes
�3 No
❑ NA
❑ NE
❑ Yes
54 No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
12128104

Type of Visit &G-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Eioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: o Arrival Time: Departure Time: 3 County: 4T— Region: Q
Farm Name: LL(EFE b2 u r 5 r-r % Owner Email:
Owner Name: PeC - 5art. Phone:
Mailing Address: �a_! n�! �� Tf a L h�Dr� C .
Physical Address:
Facility Contact: Mal-k Pe ocrS Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: _ 5��_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o F--� i = it Longitude: = o = 1 0
it
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
&, coo
❑ La er
❑Nan -La er
D Poultry �.�.�;�+ ...
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean'"
El Farrow to Feeder
.ry
""
❑ La ers
❑Non -La ers
El Pullets
Turkeys
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
❑ Farrow to Finish
Gilts
PBoars
Other-�`
❑ Turkey Pouets
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
gNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
RNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
E(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?
Page 1 of 3
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
14No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
JK No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ 1 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
§4 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
59 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?
R Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J4 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
X No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > lo% or ] O lbs ❑ Totai Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
�I" .. .: _ ern MWA
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
01Yes
❑ No
❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
[,No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.oth' comments
Use drawings'of facility to better explain situations. (use additional pages as necessary):
M�im'
w�-
��/°L Uwrpej i � l�1f c'7—r 'r,l,d
/S
Reviewer/Inspector Name
Phone:
3 -3
Reviewer/Inspector Signature:
Date:
aD
Page 2 of 3 12128104 Continued

Facility Number. $' T Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility'fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JK No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[&No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EfNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ 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
14 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
(A 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
[4 No
❑ NA
❑ NE
Page 3 of 3 12128104

® Division of Water Quality
d6lity"'Number .2 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit / Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time County: _ suir*►o5erc._ Region:
Farm Name: Owner Email:
Owner Name: z2i-e.rk._ _—� �o_.s� Phone:
!�1 5
Mailing Address: O Q G t.1 _�fiL,� -.�T r_C._/K Tina _ d l- u d A:,/
Physical Address: 004, T, C:� tQ ew W ass ,&,
Facility Contact:
Title:
Onsite Representative:
Certified Operator:,
Back-up Operator:
Phone No:
Integrator: 'r
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 O 0 I = 11
Longitude: 0 0 = i ❑ «
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer G D oA ❑ Non -Laver
❑
Wean to Finish
Wean to Feeder
El
Feeder to Finish
El
Farrow to Wean
El
Farrow to Feeder
El
Farrow to Finish
El
Gilts
ElBoars
Other
❑ Other
Dry Poultry
❑ Lavers
ElNon-La Non -Layers
El Pullets
ElTurkeys
ElTurkev Poults
El Other
TEI
Discharp,es & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ Dai Calf
El Dairy Heifet
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the Statc? (I f yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E]
d. Does discharge bypass the waste tnanagetnent system? (if yes. notify DNVQ)
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 ofthe State
other than from a discharge'?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
[I No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
U No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
12128104 Continued

Facility Ndniber:
Date of Inspection I 6X2� o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes.. is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?: /: o!
Designed Freeboard (in): --.
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 5 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [� No ❑ 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 ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5fl No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? 1 f 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 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
ror
12. Crop type(s) � id=. -- O 3
13. Soil type(s) AU
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
[4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[y No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any reeommendaUons or any other commeats.
Use drawings of facility tof�lain sirt�uations. (use additional pages as necessary):
�t r M ©A_) r-- 4-0,- G r
/ice
1 _ � CP��l/t4 +C wC%r+L O� lLt10O{j C7a r C S oe4-S,
Reviewer/Inspector Name >r Phone:
Reviewer/Inspector Signature: Date:
/ / I2/28104 Continued

Facility Number: ��? -- 33 Date of Inspection ra .13 c
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components.of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
. 3 , , C
❑ Waste Application ❑ Weekly Freeboard ElAI 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 60 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [4 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
N No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[j$No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1� NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
50 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[$ 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
[31 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
[3 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P No
❑ NA
❑ NE.
33.
Does facility require a follow-up visit by same agency?
❑ Yes
09 No
❑ NA
❑ NE
AddirionaltComments;andA)r,Dra*! S
12128104
12128104

(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint O Follow up O Emergency Notfication O Other ❑ Denied Access
mate or visit: S ,D'd Tiiue: ! ?� SAh
Facility Number
Q Nat O erational O Below Threshold
Ml� ermjtted 12-11fertified 13Conditionally Certified
0 Registered Date Last Operated or Above Threshold:
Farm Name: �... a ._ N�:! ., . ! e.0 ..... .--
................ - .... — -- Couanty:...........�97U ......... ............. . L?.._..
Owner Name: r .... Phone No:... .c
Mailing Address:..W���...!�l/le-
Facilitv Contact: -------Title:
............... .... ...... Phone No: y/U- �$�- �L 70_.....
Onsite Representative: r1C pr' n
........._.....__ Integrator:..._
Certified Operator: .............. . .. �.__�L.... ....... _.......... ........_..._. Operator Certification
Location of Farm:
(g-Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude • ' 64
Swine Cac�ity. P
O-Wean to Feeder
o
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts .0
Boars
- _ -Design Current _: --
Poultry- CabaChi ..Pooiilanan- . iCat
❑ Other ` -
Total Design "Ca
paci
,,.
77,
Number of Lagoons � �� W
�.�
'Hnlrlrtiapnetrle•/Cnlrrl-'Fra�fc_ �=- �-,-___.. �'
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes e-No—
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ®`lqo-
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [}No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes giq-
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... I .... ............ _.......................... .._...........................
Freeboard (inches): 3 �Z r�
12112103 Continued

Facility Number: — J JLy Date of Inspection ap 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type U P r ,,, a .la _ S" /I
❑ Yes E514o
❑ Yes ETNo
❑ Yes ONO
❑ Yes Rio
❑ Yes ONO
❑ Yes QNo
❑ Yes ❑-Nil
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0-No
b) Does the facility need a wettable acre determination? ❑ Yes Q-No
c) This facility is pended for a wettable acre determination? ❑ Yes j o
15. Does the receiving crop need improvement? ❑ Yes QNe
16. is there a lack of adequate waste application equipment? ❑ Yes 0-No
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 Q-N(r
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes B-NS
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 B No
Air Quality representative immediately.
Cow (refer�bo_questian) �Faiplaia any I'ES answers and/or al;y<"re�mmendlatioas or any otie mments=� T , Y
Use drawings of iacdtty to better exp]atn si o s. (ose addtttana! gages as necessary) wield Copy ❑ Final Notes i
... � z •� r' .-...e�-c.:.^"" '-T, ` a R_ 'e.=.:.a_.. �.cyv.n': ";i" '� i'�y.7.�.. _...w. ,v� _ � .-. �''t.. : '"r - s.r.., d r . � . _i.3:.;
�'II PPG%jCn 1S G]rCnf� j"C O» f74"es10015 4rOtF7�
Reviewer/Inss tar Name yyy� /-� - -n — ' — -
peC 1 iir �Sn'i �10 - -
Reviewer/Inspector Signature: ZL Date: 2_ 1-
12112103 Continued

J Facility Number: 8� —33� Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0-No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ VYUP,'checkirsts, des' , pap , etc.)
❑ Yes
fit'
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O No
❑ tca on ❑ Fr and ❑ W ysis ❑ Sgll_Samphng-
S-G -'7 / • 5— a -10-7 --). 7 V-10 _2 �_ ( d , r. � -2,3
24. Is facility not in compliance with any applicable setbac criteria in effect at the time of design?
❑ Yes
ED-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
El -No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ONO
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
U No
28. Does facility require a follow-up visit by same agency?
❑ Yes
U-No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑-No—
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
©W
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Farm Name/Owner:
Mailing Address: i
Site Requires Immediate Atten on:
Facility No. 3P2 - 3
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 "� , 1995
Time:
J�,4E S M04--!`76� Il
4f6, 1�r37
County: 5 Am 5 d w
Integrator: r e-3 Phone: q �� -9� - �yo
On Site Representative: A112 • e±` 0 1 / n� � T Phone:
Ph sical Address/Location:l��� -�' fly, /Li o� / �� - /S/,a,/,� ��s t /�rr�,rs
vfl�5 - J�gM.'1._ r^LI rt4 wn - fug
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: zf o0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Uor No Actual Freeboard: _ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or 96Was any erosion obse ed? Yes ordv
Is adequate land available for sp
Crop(s) being utilized:_
? or No Is the cover crop adequate? eOor No
T4eeKjj�44;P,4
Does the facility meet SCS minimum setback
criteria? 200 Feet from Dwellings? "e or No
100 Feet from Wells? I(ei-
�ir o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 19
Is animal waste discharged into water of _ft state by man-made ditch, flushing system, or other
11
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y or No
Additional Comments:
Inspector Name
0- Y'
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

t
NORTE CAROLIl'A DEPARTMMU OF ENVIBMCENT, EM#LTH' b NATORAL RACES
DXVISIOH OF ENMOMMiTAL
Fayetteville Regional Office
Animal Operation Compliance inspection Form
.`-.+Ya�MC��:y;.:Av ..�• ��:.`y�.'.��_�.�yeL�t��_nt�nr!�iP�
T'�`"r.-,
�"`-^Yr'y. `�'47�1' •�N ^Pa�2�.��K�Y•rw....i. �..
M1 i\ffCip/.�:^x
XW.
s„!�+S.Z iiLiei�-�n:rcWr
I rn MaCL)i I I me "acC-ri ! )
'..-..:w.-Ma S .r.�* ...w-. �.....r .�i ..^' G - .OxOm". � ., �, M � :t-
kid,w.ifT'1�•'•.'i'6ffJ-x+-�-mT,,.1{!-�7di:.��7�i: '"�°"o.w^�f-ti;f •A�%a�4
�!^- y �<^'✓ ¢.e w �4.""'y"'�. v.i .'' -M' F µ...Tw+.o.+.',::
�vs�.. �wii+�..�..�a\JL\Sr ��.illlasa�{.he•.v
� iiL.iL13S
iU-o -Fo
�5 7-
All questions answered negatively will be discussed in sufficient detail in
the,Comments Section to enable the deuced Permittee to perform the appropriate
corrections:
SECTION I
Animal 0oaration TMM:Fin 1 S
Horses, cattle swizte poultry, or sheep
0=10M II
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)]
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 CE RTTFnM a1AIl�lAL
WASTE NAKAGEMERT PLAIW7
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. noes this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
T I N I COMMENTS

ti
�Q
kip,ld Site Manjigement
t. 7o animal aabLd sLockpilsd Or lagoon
construction within 180 ft. of a DSCS
Nap Blue Line Stream?
Z. Is animal waste land applied or spray
irrigataA w;tt,in 25 ft. of o UGGO 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
QgMIFICATION VIM?
S. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(EMP) of the approved GOTUICATION?
7. Does animal Waste lagoon have sufficient
freeboard? How much? (Approximately )
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
BMW lY
C=ments

P GIS7RA I0N =ORM. FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feed= ct operation is
designed to serve more than or equal to l00 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and :nailed
by December 31, !993 Pursuant to VA NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name : _:S7m �OcGiil
Mailing Address:
Cz - _P 1, Q
Phone No. -
Owner (s) Name: W.r ws 7 - NO CM (3 11
Manager (s) Name .. .__
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
:milepost, etc.) :.iW� L a h_ r-ii in-P C'11n-�-n (-,r-� -7r•,) f nG nn
r. PN-)P- l-�i_ V 4_ r n t 1e _�+ �7 +Py �' ttw.r r. • "JOP Al( -
I C,t rv% t 14, -� r :--F•i�tia ._ -a-r . ri !� . i" \ � /l C�.-.,�.. :-.., .-.. _S . ., -.•. T''. 1 :v r \
Latitude/Longinude if known:(7atQ1 Ill-O
Design capacity of animal waste management system (Number and type
of confined animal (s)) 810) Efeder in 0 Any,
Average animal population on the farm (Number and type of animal (s)
-raised) : Same n. l2 hC_4-__.
Year Production Began: j 7767 ASCS Tract No. _T-7-3if T�11614 j ia706
Type of Waste Management System Used: i nr ran j C
Acres available for Land
Owner (s) S ignat ure (s) .
ligation of Waste:
-31:F
.50A
DATE :