310241_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Y Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (!�O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O +j�T Departure Time: County:
Farm Name: (, Y & f rv, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ?,(Uul n q 10 4 0 l o 8"6 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: f 7 177
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Desigrt Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
3
D , P,oul[ ,
Layers
Design
C•a aci
Curreut
P,o ,
Da Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
a
❑ Yes 'k No
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes FE No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 71No
a. If yes, is waste level into the structural freeboard? ❑ Yes *No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 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?
ZVI
17. Does the facility lack adequate acreage for land application?
❑ Yes
EA No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
r%2 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes l,{.I No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes "�"T❑CCCC'"] No ❑ NA 10 NE
Page 2 of 21412015 Continued

Facili Number: 3 1 - Date of Inspection: ,S
241 Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J!pNo
❑ 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 PDA 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
JUNo
❑ 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
IoNo
❑ 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
-U�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
jo No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
7 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?
CG'�'prc�-ticrn LIII (1
Cis
Reviewer/Inspector Name:Q Y'
Reviewer/Inspector Signature:
Page 3 of 3
Yes ❑ No ❑ NA ❑ NE
❑ Yes 4�No
❑ Yes Q No
❑ Yes XNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: q 101 10 I"
Date: I
2/4, 2015

for Visit:
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Referral
Arrival Time: Departure Time: ®County: Region:
Owner Email:
Title:
Phone:
Onsite Representative: S,/, O ( rT' Ll (l0 4-^ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: /// L(
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
CapaciTy
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
3 00
Design
Ca aci +
Current
P,o .
DairyHeifer
D Cow
Non -Da
Beef Stocker
Gilts
Beef Feeder
Boars
VLayers
Beef Brood CowOther
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 E]-1q_o_❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes allo / NA ❑ NE
[-]Yes o ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - 2 Date of Inspection:
y
'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: I
Spillway?: T
Designed Freeboard (in):
Observed Freeboard (in): 'Y 3
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
ONo ❑ 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 [J'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3No ❑ 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 [Z io ❑ 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 [J�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
6] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[TNo
❑ 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
[fNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes g�No
� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilt Number: Z Date of Inspection
'24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
]o
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes ❑ No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes [-No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations br any other comments. I
Use drawines of facilitv to better exulain situations (use additional oaees as necessarv).
C
fG
9�
d�t`t lIf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I I (J 71 t % 3("l
Date: I I 4 ) k
2141201

Type of Visit: yd'Com liance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: ( outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I t Arrival Time: 0 2p Departure Time: / !7 S`D County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
o-1 1 IS row,^
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
W.et Poultry
La er
Design
Capacity
Current
Pop..
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
4409
D . P�oult .
Layers
Design
Ca aci_
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I Beef Brood Cow
Other
Other
Turkeys
TurkeyPouets
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 ZrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [�] N ❑ NA ❑ NE
[:]Yes L.4 No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
11. 5-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
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 ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E 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 E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
��
E No
❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q 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?
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
/ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0-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 dNo ❑ 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 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Io ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FBeility Number: 1 - _4 I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
r ❑ Yes
�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E3'5�o❑ 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
O 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
E/ No
❑ NA
❑ NE
❑ Yes
NA
g�No
❑ NE
❑ Yes
❑ NA
❑ NE
t,
Reviewer/Inspector Signatm
....,..., I V - �I
Date: )// l 2�/ 1
Page 3 of 3 21412015

II ype of visit: ,t t comp lance inspection \J uperanon tteview V atrucmre nvamauun v t momicat asststaucr I
Reason for Visit: 9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:
Departure Time: County.tk xj Al Region:
Farm Name:�j4(i(cpq �[ /a-J� Z+ (ZcA N S 2 F4 (Lrt1 Owner Email: —Y�
Owner Name: 0 QfktCY4 D 544N T j>iZ W Phone:
Mailing Address: �g L1 �C�6LQ (_ �I tNM �H d� R �Lt 9 C� , NC ec'4yyp
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Integrator:
Certified Operator: I t /tQ I GYV 1\ -Vyta �N �� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
—41-4-4
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Pointry
Layer
Non -Layer
Design
Capacity
Current
Pop.
Design C•unrent
Cattle Capacity Pop.
Dai Cow
Dai Calf
Feeder to Finish
'-I
- Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oul .+
Layers
Design
Ga paci �
Current
Pao ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I jBeef Brood Cow
Other
Mi Other
I IOther
Turkeys
Turkey Poults
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 4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
[—]No
❑ NA
❑ NE
❑ Yes ❑y No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facilf Number: - . y I Date of Ins ection: 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes '1111❑D No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I of
Spillway?:
Designed Freeboard (in): ) C) .
Observed Freeboard (in): L4 6 H 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? "`fff"""`
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 ���JJJ
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I yd No ❑ NA ❑ NE
maintenance or improvement? 1r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes yd No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. 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
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
I
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
vt,
K 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.
Q WUP ❑Checklists Q Design 0 Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Tratills;fers Q Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ 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

lfadtity Number: 1 jDate of Inspection* I I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tI YI No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below. 7�
❑ Failure to complete annual sludge survey [:]Failure to develop a PDA 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
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�../,
!ly I No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
�C
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
* o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessary): "
CA(-I6(W%'0"1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: " 1)U -_j9(O S6
Date:
21412014

Reason for Visit:: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Othee/r�! �0 Denied Access
Date of Visit: I N /JK// S I Arrival Time: T. Departure Time: .`� County: Ityr4�[ y� Region:Q
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: &ayl 01 &91'.�
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: �-�
Certification Number: /
i' /' T7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
41
D , P,oultr.+
Layers
Design
Ca aci_ +
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
—TurkeyPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZTNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes .�TNo ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Page I of 21412011 Continued

[Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P4No ❑ 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: A40
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
443
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 KNo ❑ NA ❑ NE
waste management or closure plan? iiii
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 P�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 0"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.
J
❑ Yes I A No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
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 VTNo❑
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 Zj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
4pa-No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes VTNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes l `No
❑ NA
❑ NE
the appropriate box.
jri
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 Er No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [214o ❑ 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 E!fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes IL_I No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
d2l[—]Yes �No ❑ NA ❑ NE
❑ Yes O-No ❑ NA ❑ NE
❑ Yes W�o ❑ NA ❑ NE
❑ Yes Z No []NA ❑ NE
[:]Yes �rNo
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
[—]Yes Z"No
❑ NA
❑ NE
Reviewer/Inspector Signature: %di w V :it ce' Date: r v-3
Page 3 of 3 21412077

Evaluation
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: D j Arrival Time: / o Departure Time: County: r—� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: S Q37 % 9 ] .wwA/ \ Inte�grato/O
\ �r'::
Certified Operator: (� (Z� GX/ LQ W.N/ J�z _ Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
can to Finish
Design Current
Capacity Pop.
Wet Pout try
I ILayer
Design
Capacity
I IDa'
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
can to Feeder
I INon-Layer
1 11Da'
Calf
Feeder to Finish
Faaow to Wean
i, +J
Design
Current
Da' Heifer
Cow
Non-Dai
Beef Stocker
Farrow to Feeder
Farrow to Finish
I)r. P,oult Ca aci P,o .
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 4No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes [:]No
❑ Yes ,Wo
ElYes IXI No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: -9 Y jDate of Inspection: Q' j
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: M
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes K I 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) p�������.
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 ElYes No ❑ NA ❑ NE
maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �(J �[
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of (Wind Drift j❑ Application Outside of Approved Area
12. Crop Type(s): } NL1 Y 1 �� IR Il b SC
�(L/1( %/I
13. Soil Type(s): Ka/K', Ma c-ow<_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes -%No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;�No
I�T�[�
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes IX I 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 [Z Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application © Weekly Freeboard M Waste Analysis Q Soil Analysis ❑ Yaste Transfers ❑ Weather Code
© Rainfall ❑ Stocking 0 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 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 21412011 Continued

acili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IxI No ❑ NA ❑ NE
the appropriate box(es) below. ��
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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
VkNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
x I No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
.r1�
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
N I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
�777yCCC"
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit. (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes `}(I No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: T�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
i� • ff • ( ' oZ
)01- 1 i".)
/) a(,109Z4-TJ 4x1
S(_ufl66-7 S;vGLU&LS DkkE 9k�EN� 6F
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
i, 0
no))
Phone: `9/0 - TYU -
Date: /gtykQ
21412011
Page 3 of 3

Type of Visit: tjD Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
00 I
Reason for Visit: Routine O Complaint O Follow-on O Referral O Emereencv O Other O Denied Access
Date of Visit: u Arrival Time: 00 Departure Time: /® County: 1 ]4 A]
Farm Name: (njg((,/(11/ 'sb 41 W Owner Email: ��
Owner Name: / 014 LION Dco}N &Ito�)y Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:[�r� SGGT7- (��Ow Integrator:Certified Operator: 1, la�.((y((� VJQOkw �'q_ Certification
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Number:
Certification Number:
Longitude:
to Finish
Design Current
ltryattle
La er
esign Current
Capacity Pop.Wean
Dai Cow
Wean to Feeder
Non -La erDai
Calf
Feeder to Finish
1560
Dai Heifer
Farrow to Wean
Farrow to Feeder
to Finish
Dr, + P UIt .
La ers
Desi
Ca acNon-DairyFarrow
HP_
D Cow
Beef Stocker
Gilts
Non -La ersBeef
Feeder
Boars
Pullets
I
jBeef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes $No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes [—]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: "5 I - Pri) Date of Inspection:
Waste Collectfon & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
i 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: 1 oG
Spillway?:
Designed Freeboard (in): 7 1 • 7 ��.
Observed Freeboard (in): q 3 3 (j ttt
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? VO
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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): C09-N wIICCA ( A, REV-(ki\ S 6
13. Soil Type(s): \" IAI
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
W
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
! No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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.
Q WUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements ❑Other. �(
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I�(� No ❑ NA ❑ NE
El Waste Application ❑ Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ )4ste Tran] ssfers ❑ Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and V 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 21412011 Continued

Facility Number: ) Date of Inspection: y /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes co
No ❑ NA ❑ NE
Other Issues �/
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I XI No ❑ NA ❑ NE
and report mortality rates that were higher than normal? T`
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
L
IX I No
❑ NA
❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other,comments.:,
Use drawings of facility to better explain situations (use additional pages as necessary). '- Y
101:1411 1 3 o
Ala►l�� 1.9 �. �
CAugt�A-,t-n.�v OUP �I'�
5L'&D6G Cxc imq-) �Av i /L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (//�� �3��
Date: /f
21412011

Type of Visit Al,,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit $-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Region:
Farm Name: It�IhJt� 7 t�/" IJ V-114^1 UV« r - UNLyY-IvtrvvOwner Email:
Owner Name: 1 /f i)Q 1101'1I Se aA/ �ILOUw Phone: ��a -ox
Mailing Address: 4 � l_1�c� d GC �/HA/ 3N� �L 0LECACE ./ YC 92q(0(0
Physical Address:
Facility Contact: Title:
Onsite Representative:SC'3T T
%�`tJQO�w/V
Certified Operator: ! r ' XWY h • `s-\n,>aQl-W IV -
Back -up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = = Longitude: 0 0 = '
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity opultion
Cattle Capacity Population
LI
❑ Wean to Finish
❑ Layer
EDaiyCow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El Farrow
Layers
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑Beef Feeder
El Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes l)(1 No [I NA [I NE
❑ Yes ,❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes tNo
o ❑ NA ❑ NE
❑Yes ❑ NA ❑ NE
12128104 Continued

�FacilityNumber.
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 S cmre 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
n)
Observed Freeboard in :
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes p{J No
❑ Yes �❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ Yes )�No ❑ NA ❑ NE
❑ Yes XNo ❑ 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 El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA [I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require aA
❑yesNo El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? �No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes ElNA [INE
ElExcessive Pending ElHydraulic Overload ElFrozen Ground ElHeavy 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
12. Crop type(s)
13. Soil type(s)
SZ
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
Application Outside of Area
1 ')(5�
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I No ❑ NA ❑ NE
�j'j�" ,No ❑ NA ❑ NE
No ElNA ❑ NE
No ❑ NA ❑ NE
o ❑ NA ❑ NE
Commemsi'(refer to question ft Explain any YES answers and/or any recommendations:or any other comment`s�
.
Use drawings of facility to better explain situat_io.,ns. (use additioniFPa es as necessarY)
Reviewer/Inspector Name
jaAlDaW
Phone: _338�
Reviewer/Inspector Signature:
'Date: /L\
Page 2 of 3 12128104 Continued

iFacility Number: Date of Inspection
Reauired 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 ❑ Yesl� V No El NA ❑ NE
the appropriate box. ElWUP ❑ Checklists Q Design El Maps ❑ Other 1✓
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑)kual Certification
* Rainfall ❑ Stocking El Crop Yield El 120 Minute Inspections 0 Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
)� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes )kNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes 'M No ❑ NA ❑ NE
❑ Yes $J No ❑ NA ❑ NE
❑ Yes ,9\ No ❑ NA ❑ NE
❑ Yes 2U No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
JAdditional Comments and/or Drawings: . , -- .1
7 fo"C i '/0 5 d L- S Aw l cC_
Onj I
Page 3 of 3 12128104

Type of Visit Xcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Cj 49 Arrival Time: Departure Time: County: Region:
Farm Name: M �0MON �EAN i n90-k)N . 9 T(-J�/�'1 Owner Email:
Owner Name: 1 �/i�PQ40,V/��AN Q� �r 1P'honne,: �/—�(��c( �/�
Mailing Address: `-1!90 l_]��-GE \ tNAIVA( 5K0LEf_�iZ »}t_LACft-,/t�C 109C D(O
Physical Address:
Facility Contact:
Title:
Onsite Representative: S co-rr QRawd/
Certified Operator: M proo/V t� . IQOWAI t 3 Q.
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: Mo [7. [ Longitude: [70
M, n
r
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er I
❑ Dairy Cow
❑ Wean to Feeder
I ILI Non -Layer I
❑ Dairy Calf
Feeder to Finish IL11,03 I
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Laers
❑ Non -Dairy
Farrow to Finish
El❑
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Pouets
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ICJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
FNo
❑ NA
❑ NE
12128104 Continued

. Facility Number. — Date of Inspection
Waste Collection & Treatment �,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes lal No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes /❑1 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in): 4y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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? to
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
ElNA ElNE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
ElJCS Yes
,0
No
❑ NA ❑ NE
❑ Excessive Pending ❑ 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 [I Evidence of Wind Drift/ El Application Outside of Area
12.
Crop type(s) CWo(IAI j4r= i S l9 Q EZ64� S \,
13.
Soil type(s) e4 /N 3 Noacic
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 acre determination ?
❑ yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA ❑ NE
Use drawings of facility to.better explain situations. (use additional pages as necessary)
._ ..1 ,.....ta
LuCYZ1C oN CQW s� In/ p1 uo-r F IF
Reviewer/InspectorName I Hmi9/v0t9 bAINEN ='`"`"Phone: r'%/0'1i(0"YoLt
Reviewer/InspectorSignature: ml. ANC' Date: 9bo%CA
12128104 Continued

1
Facility Number: 31 —9411 Date of Inspection EX&a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PqNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists 0 Design ❑ Maps ✓✓✓✓✓✓ \\\\\\
p El
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard El Waste Analysis El Soil Analysis [:1Waste Transfers ❑'/nual Certification
EIRainfall ❑ Stocking E]Crop Yield 0 120 Minute Inspections [D Monthly and V Rain Inspections E]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?
w.A. l 09
4/D l/O 9 /. & /. Ll
5/6/oq 9.0 /.q
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�] No
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
t�
kyl No
❑ NA
❑ NE
❑ Yes
0 No
ElNA
❑ NE
[IYes
KNo
❑ NA
❑ NE
❑ Yes Dd No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes i0 No ❑ NA ❑ NE
12128104

t
a,--7 Division of Water Quality /
Facility Number > I N O Division of Soil and Water Conservation ✓`
_— _ __. —__ Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1 2 Departure Time: County:'b Pc./�v Region:
Farm Name:
(� Owner Email:
Owner Name: 1' ,/y� 1AEZ.IW hEAN Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Q
Onsite Representative: O 07-7 At�(�cpw
Certified Operator: Mpn.ton( 'b • taot.,w , 3R
Back-up Operator:
Location of Farm:
Design Current
.Swine.. Capacity Population
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number: ' —414-1
Back-up Certification Number:
Latitude: = U = ' = Longitude: = o = ,
Wet Poultry
Design Current
Capacity . Population Cattle
❑ Layer
I
I
❑ Non -La er
Dry Poultry
NDai
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design .
Canarity' F
Calf
'i 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?
Page 1 of
❑ Yes ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
No
❑ Yes
���❑l/
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
1228104 Continued

Facility Number: 3 I — j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Strure 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 6No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes M 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 IV No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
[INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
vvp
El Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
ElNA
[INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
���yyy{{{
❑ Yes ;I No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
�{
El Yes i No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes R?No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ONo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,kTNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
THe piF lE PETWEaN TNET"-X�) L146gW;Vx 15 c LoCGED - CACD0143 wtt
Q� QL,MPch Dc�wx-Soc�A( so 17 CAw Rif C<_&,WE�
IReviewer/Inspector Name A atb4 3Phone: i110
Reviewer/Inspector Signature: Date: /0Irlc f('
Page 2 of 12128104 Continued

Facility Number: — j Date of Inspection /V
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 XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A 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 14 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes -14No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes I\'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El'IBC Yes 'N.o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes _�l No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[:]Yes rNo
❑ 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 RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes IkNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes V "No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 12128104

Aa
t7 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
d
-- -- - 0 Other Agency
Type of Visit Coomphance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit to Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O 7 dG Arrival Time: Departure Time: County: ,OUPQ_N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Sc.' ir Atu WN
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = .
f f = Design
Current "
Design Current_ Destgn,� ;,Current�x"
Smne Capacity
Population Wet Poultry
Capacity Population CattleCagactty Population
El Wean to Finish
❑ La er.
❑Dai
Cow
x ❑ Wean to Feeder
„
[E]Non-Layer I❑Dai
Calf
' Feeder to Finish ZO
r---
ldp❑Dairy
Heifer
D Cow
❑ Farrow to Wean
Dry Poultry .
❑
Non -Dairy
�-
❑ Farrow to Feeder i= ❑
❑ Farrow to Finish
El Layers
❑
Beef Stocker
�i 0 Gilts
. ❑Non -La Non -Layers
,r ❑
Beef Feeder
Boars a
❑
- ❑Pullets
❑Beef
Brood Co
-
.,
— — - ❑ Turke s
'
Other
❑ TurkeyPoults
..x.
ua
❑ Other I
.
If ❑ Other
Number,,of Structures ?
s
J "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes LQNO ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
] o ❑ NA
❑ NE
❑ Yes
❑ Yes
[INA
❑ NE
❑ Yes
� ❑ NA
❑ NE
12128104 Continued

FacilityNumber: — / Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (�A coo (A COON -11
Spillway?: /—
Designed Freeboard (in):
Observed Freeboard (in): 3 37
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 Vd No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA [INE
❑ Yes OENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalth at, notify DWQ
ty
7. Do any of the structures need maintenance or improvement? ❑ Yes ,�JN/o El NA [I 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 El Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C CJS (9 C H) �_6 0
13. Soil type(s) RAT_�s tjo/z V-6 LX
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
ET No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2-No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
r�N)ElNA
❑NE
18.
Is there a lack of properly operating waste application equipment?
ElYes
o ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name IT Phone• /f!
Reviewer/inspector Signature: Date: p
Page 2 of 3 / I2128104 CbnBnued

Facility Number: — Q I
Date of Inspection
Required
Records & Documents
%
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El�u/Yes
To
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,��,//
L3No
❑ 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?
❑ Yes4�3/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IT Noo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[J,
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[��
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
9'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
OXo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QNto
❑ NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L.�d<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
[ <o
❑ 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
ElYes
2No
❑ 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
,,��,,//
IQNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit (JRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: SCA-Tt 3 0-,6W�J Integrator:
Certified Operator:
Back-up Operator: _
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
= Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�',- ❑Non -La et
Other
❑ Other — - I - —
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
NNV El NA
El NE
❑ Yes
❑ Yes
,❑,
�N ❑ NA
❑ NE
ElYes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — ay, 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
StructureI Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA Fro6 rJ
Spillway?:
Designed Freeboard (in): f r S
Observed Freeboard (in): u 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2 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 thre , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any oft I he stuctures lack adequate markers as required by the permit? ❑ Yes No [INA ElN
(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 in No ElNA ElN
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ElNA ElN
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes M No ❑ NA ElN
❑ Excessive Pending ❑ Hydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN [3PAN > 10% or 10 Ibs ❑ Total Phosphorus ElFailure to Incorporate Manure/Sludge into Bare Soil
[3Outside of Acceptable Crop Window ElEvidence of Wind Drill ElApplication Outside of Area
E
E
E
E
12. Crop type(s) Ct,>S Q 6Q VAVQA C I of _�_6 6
13. Soil type(s) 06rz— L /C RA ros
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N/ ❑ NA
IJNo ElNA
El / No ❑ NA
L�JNoo ❑ NA
LyN0 ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
IReviewer/InspectorName -- ---- --JLLW 7, 0_4'-�(:,( ,�._'"" "'''',+' `°{Phone:( "'ItD2''1IG --/o2L,,j" I
Reviewer/Inspector Signature: Date:

Pacility Number: 3 —a Date of Inspection n I oS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes �No ❑ NA ❑ NE
❑ Yes [7No ❑ 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 i"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
�� //❑
Li'ivo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Now ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,O
I NG ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,E
LD�,d'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
I�'No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
//
LSO ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
61? ❑ 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
wo ❑ 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
ElYes
L.d'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
IdN0 NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
NA
❑ NE
Arl'di66nal Comments,and/or,Drawings:
a.. .
12128104

A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Colleen H. Sullins Dee Freeman
Governor Director Secretary
December 3, 2010
Marion Dean Brown
Marion Dean Brown Jr. Farm
468 George Dunn Sholar Dr.
Wallace, NC 28466
• Subject. ':Sludge Survey Testing Dates
Certificate of.Coverage No. AWS310241
Marion Dean Brown Jr. Farm
Amm' al.Waste Management System
DuplimCounty.
Dear Marion Brown
The Division of Water Quality _(Division) received your sludge survey information on.Noverl
4;,20.10: With.the survey results,:
on requested, an extension of the sludge survey.requirement
for. the. two;lagoonsat;the IVlarion Dean Brown7r. Farm facility. rDue to.the-amount,oftreatment
;:<"
volurrie available, the`Divrsron agtees that a sludge surv__ey isnot,needed`unti12012 for;your
lagoons. -
The next sludge survey for the two lagoons afMariorl Brown Jr: Farm facility_shouldibe•-,'.-,"
performed:before December 31; 2012. Thani you for your attention to this matter.. Please call •: - .: ?-
me at (919) .715-6937'if you have any. questions.'
Sincerely,:.
Miressa D. Garoma:.
Animal'Feeding Operations.Unit
cc: Wilmington Regional Office, Aquifer, Protection:Sectron DEC- :0 9 20
Permit, File AWS31024110
1636 Mail Service Cuter, Raleu h. North:.arclina M99-1636 - rf OrtilCar011llc'l
Location: 9773 Capital Blvd.. Raieiah, North Carolina eNir
Phone. [phone] FAX: 919-715-OS&B?Cistoiner Service: 1E77-623-6745
InfFa=t vxw nr vatemna!ifv.nm
?n eaul Cmm,Y:rfN! eflima ce Action `cme4mer

Facility Number Date of Visit: $ r7 Tune: F 1 754°
O Not Operational O Below Threshold
ermitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: —
Farm Name: ___MArit i C�A►✓_t$,q aN11_c�'2,_FA=n- County: OLCUji-------_—_�
Owner Name: ------ Phone Phone No:
Mailml; Address: _--
Facility Contact: _ Title: ___ Phone No: _
Onsite Representative: _ +� T BVLol-� _.. Integrator. CA 44ZAL"o _ __--
Certified Operator:-------.r_� Operator Certification Number.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• = 0- Longitude =• =' =-
Des>grn -Current = De4gn
Curtreat -
roesi Curren
Swine Ca
Mahon`; zPoultry
Po ` Cattie
Ca Po Mahon
an wPo
. _..Ca`aa
hon _
aat :i
Wean to Feeder
Layer
Dairy
eeder to Finish
'3
ao
Non -Layer
Non -Dairy
Farrow to Wean
-
Other17
s
4
Farrow to Feeder
TotalDestgn=Capacity
Farrow to Finish
Gilts
a
Total SSI:W-
'.;
Boars
N®bera�fLaguons -�EE3
Dlschames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Stuucture I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __ / Z
Freeboard (inches): 31 3 _
12112103
❑ Yes Lyt`io
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yeses No
❑ Yes (�N0
❑ Yes U90
Structure 6
Continued

Facility Number: ) — Date of Inspection / �/
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E? No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Uol io
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or enviroumental threat, notify DWQ)
7. Do any of the structures need maintenancefimprovement? ❑ Yes 0A/o
8. Does any part of the waste management system other than waste structures require maintenancelrmprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes pNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceltmprovement? ❑ Yes q
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes o
❑ Excessive Ponding [I PAN ❑ Hydraulic Overload ❑ Frozen Ground [ICopper and/or Zinc
12. Crop type &Q of t'o'A ( k1 5 C� C�S 0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [fN
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,Q��� N��N9
b) Does the facility need a wettable acre determination? ❑ Yes ldN
c) This facility is pended for a wettable acre determination? ❑ Yes p
15. Does the receiving crop need improvement? ❑ Yes [�'N///o
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation? �
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 2140
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes cado
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 o
Air Quality representative immediately.
CpIDl,MnlS (ret'erago, n /rE�zplam aayl'ES amcwers araUor any nmomahons.or any{otheeommwts."---.� x
use"arawutgs r>so7tty to beita acplarn stm�a"raas. tase�aaarho�I'p� �*5) -❑Field COPY ❑ Fiaall Notes �
5pth6 , lsstl coup A.s 31— 2_q6
Reviewer/Iuspector Name 2 _ C 6 1J *,21` 'xr
Reviewer/Inspector Signature: Date:

Facility Number: 3) -ayf Date of Inspection 30 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
zo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
e
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Of6
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q/No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ZN
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
lG Nvo
28. Does facility require a follow-up visit by same agency?
❑ Yes
o
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) a4es 0 No
31. If selected, did the facility fail to install and maintain rainbteakers on irrigation equipment? ❑ Yes O/Np
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 20
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes Z1 p
34. Did the facility fail to calibrate waste application equipment? ❑ Yes N
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 41�''0
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.A:�:`3 .. •Y%:_.i... a a � � Y�....s�ix�'aZ.au+`ur.CvCiz�.a. �.s.. �� �'. _.. �+ v..r�i.-�..-.µ 3...n .. _.:.� yAsX-• 1'•in... .....«..�-. er-..... \..i
12112103

Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint J6Follow up 0 Emergency Notification Q Other
Facility Number Date of Visit:
td Permitted DC)'e)rtified Q ConiJi_tionally Ce 'fled [3Registered
Farm Name: /j/ /
Owner Name: Z2Uze
Mailing Address:
Time:
❑ Denied Access
Date Last Operat r Above Threshold: _
County:
Phone No:
Facility Contact: �/ - Title: Phone No:
/T
Onsite Representative: d U2AIK,4Z Integrator: &�/Q
Certified Operator:
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =' =` =� Longitude =• 0` =-
- Design -.
Swine- Capacity
Current
Population
Design Current -.: _`Design Current
Poultry Capacity Po ulation Cattle Capacity Population
[ILa er ❑ Dairy
❑ Non -Layer I JLJ Non -Dairy
-
❑ Other
Total Design Capacity
Total SSLW
❑ Wean to Feeder
Feeder to Finish
-
❑ Farrow to Wean
❑Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Drains
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Bow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus stone storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
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
El Yes
El No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement? -
❑ Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility tack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
t9Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
JaU Field Copy U
mY Final Notes y,?}
r
�OGcn�uP (/ONF GDN 2ria�G- C/ySGtii42G� �NdF_STzG A7Zo
A"002-rF0 7;�A7 IY'/D2R�7 (�io�FST /v lam`�2.r.
,O�Ny 6o,)^_)6R1n W,� 44v6G9io�--,/J 4 46,4k a4,�, -
Reviewer/Inspector Name
Signature:
Date:
05103101
Continued

Facilih \umber: 9J—N11Date of Inspection
Odor Issues ,
26.
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?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted.? (i.e. broken fan belts. missing or
or broken fan blade(s). inoperable shutters. etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
F��T
a
ovil' iq Sa4T7D ITT P _pRAr-TC U LXEP �Nr_�'D 14L LRR �F
Sys7�m WA5 qua FROM (Q`.3 � 7'AP- CeA
PLj.o-r Pap k �E{iL (,i)�g Rua Rnl2r..+25 ( F �2qM
RECNECKFA iFfE �a`IFz��• � �Q�SEGz�IFP ��
OF Oa6T I ROE) - Fe�o
— s. p2o ��7 D�sE�v� W►t�aE (.�asF� �,� (,�� T�
CccNretz P�vo-r AREA pwo ENf Te FT��� 1.
RRpS sew 3, �F R�f7�zn1 �N I® /Ze 11o3_
Alp F'oe,- AILD �—U�L C/� Z31� DN 10�z�A93
�) FEZ` to ©� a�5%3
Gf ✓e1, SE F � �fy--
05103101

Type of Visit F Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit tp Routine 0 Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 0 Time:
11171 Not nneral
O Permitted 0 Certified D Cond-a-t��)onally Ce ' red [3Registered
Date Last Oper or Above Threshold: n
Farm Name: �C� II `✓ Q��a t "'�M County: �P�� �i V
Owner Name: W Uloi qlk Phone No:
Mailing Address:
Facility Contact: N
Title: Phone No:
Onsite Representative: 'e// ro to ; CD ? fIntegrator: ( A-Rmr—c 15
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =' 0` = - Longitude
Design
Swine 'Ca adi
Current
P,o ulation ,$oultry
'Design Current '' ''"' Design Current
Caaci ` P,o ulation, Cattle Ca aci P,o ulation -
❑ Wean to Feeder
❑ Layer
❑ Dairy I
Feeder to Finish
-., ❑Non -Layer
11 k ILINon-Dai
Farrow to Wean
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of LagoonsM10 Subsurface Drains Present ❑ La oon Area 10 Spray Field Area
Holding Ponds / SoGd Traps ❑ No Liquid Waste Management System
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Slm to 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Z_
Freeboard (inches): 50
05103101
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes rrr�No
❑ Yes t I]No
❑ Yes /L11 No
Structure b-/T
Continued

Facility Number:MEEMDate of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?? ((iie/treeees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(It any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
1No
I[J No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
((( /
elevation markings?
❑ Yes
/r�Yi No
Waste Aoulication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
���111
�[J No
11. Is there evidence of over application? ❑ Excessive Ponding\ PAN ❑ ydraulic Overload
6
Yes
/ No
12. Croptype i-6a Itl -��1 0k a �_ 7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Manage ent Plan (CAMP)?
❑ YesNo
1,o
14. a) Does the facility lack adequate acreage for land application?
El
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment?
El
,,,__111No
l!J'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yeso
fNo
21. Did the facility fail to have a actively certified operator in charge?
El Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
( No
24. Does facility require afollow-up visit by same agency?
❑ Yes
ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N0
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
f�
Comments.(riter togfquestion#t). Eaplam any Y,ES answers'snd/or any�recommendations or,auy they comments„
....,. - -� z - s -a, - �,te
ddwmgs
Use of facility to' better explmn sttuations(use addtbosnal'pages as,necessary) .Field Copy❑ Fin
_
a l-Raa�l� 1� c R As EI'= ��Ec��o, Lam' DF FREE:6082.D
��> RFeOff`1n�h�� G£r��rJQ u%EC�A(3LF_ �CRCS V��7F-P, Ai7D
Reviewer/Inspector Name
Reviewer/Inspector Signature:
05103101
Date:
Continued

Facility Number: 2 —7d Date of Inspection JI5l Printed on: 7/21/2000
Odor Issues J
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes 1Q No -
liquid level of lagoon or storage pond with no agitation? /������//////
27. Are there any dead animals not disposed of properly within 24 hours? El Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [�N0
roads, building structure, and/or public property) /
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover? ❑ Yes ❑ No
Additional:Comments'an orDrawings: -
o- j ER()rLL,
�ECORDS -To �'RPF4�o
P-r �_°I I D�
5100

tc p _
[3 Division of Soil .and Water'Gonse2vation'- Operation Review
Division of Soil and WaterConservation-;CoinplianceInspecUon s e
�. Division of Water. Quality-.Eomphance Inspection t -
:a
Other Agency -' Operattofl Revrew,-_:-
1$ Routine O Comolaint O Follow-up of DWO insnection O Follow -tin of DSWC review O Other
Facility Number 3 2 I Date of Inspection L '/ (. [
Time of Inspection Zn 24 hr. (hh:mm)
IN Permitted 0 Certified 13 Conditionally j�C-ee'tified E3 Registered 0 Not O era[ion'al(�Date Last Operated: ........,_._
FarmName: ...._ ................................. Count':..... ✓�! _�et�%..................................................................................................
Owner Name:D�� 8ectN11
.,., ......................................................................................................... Phone No:...........................................................................
Facility Contact:
Title:
MailingAddress: .....................................................................................................................
OnsiteRepresentative: ..... SG.e4 Jr0(�/�,
Certified Operator:
Location of Farm:
Phone No:
.....................................................................................
Integrator: ,,,,...� r g P G 1/ S
...............................................
Operator Certification Number:
Latitude Longitude �•°°
- -_Design Current Design. 'Current Design Current
-Swine Capacity Population Poultry Capacity Population Cattle. :Capacity Population
❑ Wean to Feeder
® Feeder to Finish
432d'
2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
(Number of Lagoons ® Subsurface Drains Present ❑Lagoon Area Spray Field Area
Holding:Ponds / Solid Traps = ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 19 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes SLNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 1KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 31
Freeboard(inches): .......'L.. .................................................................................................................................. .....................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 'S No
seepage, etc.)
3/23/99 Continued on back

Facility Number. —'L Date of Inspection
�% Q
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
:9 Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
® Yes
❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
j$ No
11.
Is there evidence of over application? -
❑ Excessive Ponding ❑/�PAN�"
❑ Yes
j$�No
12.
� �
C
Crop type P"i Ma i , Smell &A to t C "�/ , 5-6
13.
r
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
WNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
® Yes
❑ No
15.
Does the receiving crop need improvement?
Ig Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
U No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
,
N No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) -
❑ Yes
N No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
JR Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ggNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
$1 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
51 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP? -
❑ Yes
JK No
13' NO i iolatiotis'ot. deticienties were noted during this'visit' . Yott Vj11I. - •eoeiye do fI. urther' .
` correspondence: abblit: this visit :: `:::: `. `.............................
.
Comiitents.(refer.to;quesnon #): 1!;zplain any. YES answers and/or: anyrecommendation"s or any other cornme_nts
Use drawings of facility: to bettecezplain situations: (use'addrhopal'pages-as+necessary):
7. MOW !�`� fq oa,1 d,ke INq�ls, esGeGl�l/ ,�ner walls, -
13errmvd'A on JovIIS J Z I/needsIi1npreYenjen+, eecopnrmerO
CL4-lf%/qq OIs lieMeA �e a11go� bermvda ie k&j.- es4n611 ,
14c. Fo,e;%'47 is pem4ed -&- eh we-H-16le gcres de�v)l;na1;oh,
/S. See 0) Ab,ve, ne ed,
I°I. Gtrrevl4 Wei-4t-GinglyS%S 11
Reviewer/Inspector Name ! sl-�nCW.511" /•l�j` _ - -�` '''
Reviewer/Inspector Signature: �atis, Date: C/
3/23/99

Facility N6mber.3 — Z Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
R No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Xj No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
gj No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
X No
3/23/99A

Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
Date of Inspection I I
Facility Number t 2�\ Time of Inspection ®z 24 hr. (hh:mm)
E3 Registered [3 Certified E3 TA�pplied for Permit ® Permitted E3 Not Operational 1I IDate Last Operated:
Farm Name: ...............J:�1ttrion.......V..f:di. .....prSWk,.... _Jr:..._ Art .:................ County:......:1).!QLir...................................... .......................
Owner Name:......... 14lCiR s....... , ........ !at 1n........................................... Phone No:....�9.IG.�.l $.La..(a.73.........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: ..... N.G.1..... .�.4 tp...b.unn.... n(tbrt _ i........................... ..... IQ.o W_LL.... t1A.(I....................................... ... `A s.�l�.......
OnsiteRepresentative: ........ S 4Yr......LeJt.nSSSt9.1 ...lxAm... .ra.�%..%rewxy..... Integrator:...........SLY.AA�...................................................
CertifiedOperator:............................................................................................................... Operator Certification Number ..........................................
Location of Farm:
Latitude Longitude 00 ©' ="
General
1.
Are there any buffers that need maintenancelimprovement?
❑ Yes
§] No
2.
Is any discharge observed from any part of the operation?
❑ Yes
O( No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated Flow in gaVmin?
kiN
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
,[�j
r% No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
10 No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
(p No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lasoons.Holding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier: Uq
..........................
Freeboard(ft):...............A.-A............
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes M No
❑ Yes .a No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type?nrt4......_3n`c ��......SaVDI�r.............tsCJti
J.............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
p• No.violatioht -or deficiencies: were noted during this.visit. Nou.wil} receive no further
. . - correspondence about this:visit:: ;
❑ Yes M No
E$ Yes ❑ No
M Yes ❑ No
❑ Yes EjNo
❑ Yes Ed No
Yes ❑ No
❑ Yes [A No
Yes ❑ No
❑Yes IPNo
EdYes ❑ No
[j Yes ® No
10 Yes ❑ No
❑ Yes P No
❑ Yes No
❑ Yes No
nhz. \"' V n's 'N '�.._ 600 s.kw)a be a-)Owttl CU J e.,-adJ mrct-& 6,,v-�,(ud
�c�. C_ mot`` K[ w � tb. 'go-, &,,% p51p,Ou1J \ rpe ��v {ec) . t _
i4. 9-kWy6_% :ylcu6_` Z'v'k W's)"_ Wa.S \ i'e3 Yo 't- cLm ih Pe)() i0lh, I•%z.0147, WuP
qY0.ir..
lq. 1;exnuda i� �rclt)lzot�7 slw�lt) be cv� rcmovt�. 5•1\ qva tttt�� si�r,Jltl l,a
Ip 6W 1b^y^ \agelr'_ bec. I IqC@ . 9ermue)< rlela *ti ! 1�ovla be_ tM\41fNed (_wtej cP,. rv�
�vlo-r " "� I of Itlru,t G:r� SK
zz, Lon tieSlr�t� o� o,• ��de. `t �tA,tia� sIS 5%�aJIJ be sr. t•w,rr• t^ecovdl, p
A,m�VOXIII�nflr Fci �cr stnn\iorain slrodlr bj_ 4e,)( e1A, I�ye\L1, laws& Love1S 4&ulr] ke rtrdldee /25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: AA.1 l , A V Date:

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
DSWC review O Other
Dale of Inspection 9 3
Facility Number 3 2
Time of Inspection (3:. 24 hr. (hh:mm)
D Registered [3 Certified 0 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated
FarmNamc:.......�%&m.......&m. �....._..^kt`....................................................._...._._ C:ountv:......1- 1;.....................................................I............
OwnerName: ........ �4Sar......... ^.............................................................................. Phone No:...1........................................
Facility Contact: .......Lah........ �co;,IJ(t� ............................... Title:.......og4f.5.✓......._............../....r................ Phone No:..�.51U .. .S:.G6�. ......
Mailing Address: ...�.....`L�iy...... ht..L1i4...... ..1.[)...................... ...............1 .Zftr�l/tt�iiY.)t...lQ.0 .......................... 245-4.1..........
p
Onsitc Representahve:..._4hN..... 1]CaWI:h........ V%.Vtur ..........B.tawirv............_ Integrator: .... 4fFY..CA.�L.S............................................................
Certified Operator:........................../.......................................................... Operator Certification Number, .J..71-7-
...................
Location of Farm:
Latitude Longitude =* =, = <
awme
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number of Lagoons / Holding Ponds L
General
Poultry Capacity Population Cattle Capacity Population
❑ Layer I❑Dairy
❑ Non -Layer JLJ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW-
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Drains Present JJU Lagoon Area JaSpray Field Area
yaste Management System
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (II' yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in galhni0
d. Does discharge bypass a lagoon system? (►f yes, notifv DWQ)
3. Is there evidence of past discharge from any pan of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes U(No
❑ Yes R No
❑ Yes
1� No
❑ Yes
No
❑ Yes
[4 No
❑ Yes
f No
❑ Yes
® No
(� Yes
❑ No
❑ Yes
PNo
❑ Yes
0 No
Continued on back

Facility Number: % — LLI[
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lapoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 - Structure 5
Identifier: ........3. �.........................3.................................................................................... .
Freeboard (ft):............... U............... .............3:Z............................................... .................................... .............................
,
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......... 4.sr.sKr...........................................cvmi5A..... a ... ............................... ............. ................
.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23_ Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or deficiencies were noted during this.visit..Y.ou.will receive no further
correspondence about this:visit.
❑ Yes 29 No
❑ Yes XNo
Structure 6
❑ Yes M No
❑ Yes CUNo
R Yes ❑ No
■ �!
❑ Yes IN No
❑ Yes KNo
[5[ Yes ❑ No
❑ Yes [9No
❑ Yes K No
❑ Yes ®No
(�Z Yes ❑ No
[0 Yes ❑ No
❑ Yes [� No
❑ Yes [A No
;• A lazr . 6i (k' oweund �j ka+ - c-, Y -d d wi .
(2_ kh`es �: s or, (G(:oc�' 431 _I�' 10 sae; 2.Af-Nt &/ 444-L IQOJ J cAAt ,
Wt- C61 c_v..fJ V­k'serN,
Ry -Coask,1 16ervUJa cr Sit 0 (per tmQmvc�• h a�vcvl t`u}�p
zL_ (rr;gok�,Or\ trCcovj% SWJ 6- [CLj by y
�mis, &J Ur✓�,C r\ " Sflojj lie or. $A
7-3. Ceykt4,iCAb-or, MJ U04'" WO W¢rt.tna'
" 4eld hlrtt,6r- L0,1.0,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: J_�), 1_,- AAj _ Date:

(Type of Visit 'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 08outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 2 Oj Time: 13j
Facility Number 3 �-ti
Q Not Operational Q Below Threshold
13 Permitted D Certified i] Conditionally Certified i] Registered Date Last Operated or Above Threshold: .........................
i)crnh ?e c� �o. rm County: r
i
FarmName:.............................................................................................................................. ty' .
OwnerName:.....! q .r:......e...............ft QM.I ' 1. ST'�....._................ Phone No: ..................................................................... _.__ .._ ...........................
Facility Contact: ..............................................................................Title:
MailingAddress: ...........................................................................................
Onsite Representative:... SCni-1 r�p4� ..............................
........................... .
CertifiedOperator: ................................................... ....... ..........................
Location of Farm:
Phone No:
Integrator: ... r
Operator Certification Number:
❑ Swine ❑ poultry []Cattle ❑ Horse Latitude O.0' 0" Longitude =e =' ="
Design,
Cnt .=
Current Design Current Design ue
Swine= Capacity
Population Poultry acPopulation Ca Po ulation,
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy --
❑ Other
Total Design Capacity,_
Total SSLw
Number of Lagoons_..[[]Subsurface
Drains Present ❑ Lagoon Area . ❑ Spray Field Area =_
Holding Ponds /.Solid Traps. � ❑ No Liquid Waste Management System
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow [o Feeder
❑ Farrow [o Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......!...T........................................................................................................................................................
SFreeboard (inches): 4
5/00
❑ Yes ONo
❑ Yes AdNo
❑ Yes ,P�No
vt I o.
❑ Yes ;2zEf rNo
❑ Yes No
❑ Yes ONO
[:]Yes
JRJ No
Structure 6
Continued on back

Facility Number. 3 / - 2 `Z 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes,6 No
- seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes �rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ONo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes pi'No
11. Is there evidence of over application,?/ ❑ Excessive/P+onding ❑ PAN ❑ Hydraulic Overload
❑ Yes Mo
12. Crop type %3er'--n-,P(et Re,:j) .S. All t'!r'�'i.;'•t , GofVA) Wke't4 , 964beGLtl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management PI (CAWMP)?
❑ Yes O-No .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes )2!(No
16. Is there a lack of adequate waste application equipment?
❑ Yes &No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes 2/No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes )Z(No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes PNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ZlNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ff No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes p No
24. Does facility require a follow-up visit by same agency?
❑ Yes A No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ,0 No
. .gp
; N'-*iglaliQlis;ojftrine- rj"dg thjs;vst; • Youwiyq r .
:::::::::::.::::::::::h:::•corresuorideilce:abfthisvisit•:•:.:•:•:•:•:••.--••••.•.::::
je(, %(,,e -few,-, plecAir /A We*-461e AeeC5 de�¢rMc vot j<; ntt.�iS s�totnld be doNe `
4S 500L. 65 possible.
Tke (Gigoot. de5)yh -roe 14e -Ar54 bv,4 10,006'v1 CY-r]Zo41v" sj rejvilet2.%Feel
0; /Yee bogrQ'' confV4 tt/i-%17 Yot1✓4echr)ical Lrre(iSt -io GoWirw, 4 6✓
Make An�( heG¢SSgrvt rtnep( P,c44:onr,
711e her ,vAek Crop on yvlls V- Z. is Y-xurh;^ F^oved .since wt. 1ot54 Vi.<;+.
Reviewer/Inspector Name
Reviewer/Inspector Signature: yL^1C./.4Q_ Date: f') /7-fj/ 9) 51M

Facility Number: 3 — Z Date of Inspection 2 O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes �ji No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JZNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JZ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

igkRoutine Q Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other -
Facility Number 3 Date of Inspection
Time of Inspection J �.'.p(J 24 hr. (hh:mm)
IX Permitted 0 Certified 0 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated:
Farm Name: .......... .%..._tC!%%.......................C..I..B.................Q.l�%..�:...... County: ..... :...r:..........
Owner Name: .....,,,6/..il,�i..........................J..1.(�l.U{.......................................... Phone No:../../�' /� . ry p.S�y...3....... .
SL/ ... .. 1 %!.. ...cz Q.%zZ2 ........................
Facility Contact:..L!......eL...�,�.F'(...................... Title:................................................................ Phone No: /..��...4.a [I................
Mailing (((... ..................... .
MailingAddress: .........................q................................................................................................................................................................................. ..........................
Onsite Representative:...... �..... ......... ?1ea.K ........ Integrator: , L-�LJ%�D6
Certified Operator: ................................................. ; . ............................................................. Operator Certification Number:
Location of Farm:
Latitude =•=1 =11 Longitude =• 01 =11
Design _,.,Current.
Design :' Current ,' --Design: '-.Current'
Swine Capacity.'
Population
,:
Poultry Capacity ty".Po ulation " =Cattle_ ..ciPopulationat''
[3
Wean to Feeder
❑ Farrow to Wean
❑ Farrow [o Feeder
❑ Farrow to Finish
❑ Gilts
❑Boars
viscnarges m arream rmpacs
1. Is any discharge observed from any part of the operation?
Discharge orieinated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
-A/fi'
❑ Yes ❑ No
❑ Yes ANo
❑ Yes >No
❑ Yes RNo
Structure 6
Identifier:
Freeboard (inches): ._,,,,,,,,.j 31 ,
.....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ANo
seepage, etc.)
3/23/99 Continued on back
viscnarges m arream rmpacs
1. Is any discharge observed from any part of the operation?
Discharge orieinated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
-A/fi'
❑ Yes ❑ No
❑ Yes ANo
❑ Yes >No
❑ Yes RNo
Structure 6
Identifier:
Freeboard (inches): ._,,,,,,,,.j 31 ,
.....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ANo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31 — 2 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1� No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an ,, ``
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? rv,rL^xes❑No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes [A No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ®No
11.
12.
Is there evidence
eeyof over application?
/ J❑ Ponding ❑] Nitrogen
Crop type L..,..G�Ni_!Pj.......RL�....�tG1 r..................................................................................................
❑ Yes
IANo
13.
Do the receiving crops differ with those designated in the rtified Animal Waste Management Plan (CAWMP)?
❑ Yes
IXNo
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
rVI No
15.
Does the receiving crop need improvement?
1 Ves
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
94 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design; maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
IMYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
K'No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
.❑ Yes
O No
24.
Does facility require a follow-up visit by same agency?
Yes
jffNo
0'
Nn.viWitions or. deficiencies .were noted durin'g ihis-visit; - Y'ou Wiill.receive not further.....
;•btjrrespondeitee:abbitt:thisvisit.:
; :: :::•;•; :•:•:•:•;;•:•:•::•:.:.:.:.:.:.:.:•:-;•:•:•:•;•:...
Comments (refer to question #): Explain any YES answers and/or any -recommendations or any other. comments.,,,.'- - '
Use drawings of facility to better explain situations. (use additional pages as necessary
)114Nl �AA�O%1 ctWk11.s a^t hehr.�L -1 5 %Viaec WGte: WeVh..r
/DK tr %/•e � ay roolrN+s fka Maty be -Aiy/)3 7+'.hwrrow in lar ^-'Anq diet r.,,tc/is.
15)�xF�ns)rc warp- needs b_, or,O o„/ Btrw�ud✓ (V: <4ko'tli yl. t}OeIV 1itv2 as
wtolid� v4trr,r) }o go,l t�alysis•: Fvllow—L~p i wLy he- Claw--e 6y 1�W Faa
CkeGA (DrIX i Pvk a� - e s� to a �cw Weeks• l
yt / S-lz.. vv;4, �. t
�q�J /�lc.t ��alS�t NMa1v5i5 iTnrNttiiakl� "h AAy ' /aI
1/. U-4)I /A'/, YIL 11 cI �/Jln '1 l/a./Jj /'i.�- lr i•�`i._ r-,,,,..✓.. n. -._L 1. fZ_�_� /
Reviewer/Inspector Name
Reviewer/Inspector Signaturr! may,, / / ��[�j (mm Date: L�— ��� ev II/ 6/99

Fr -
Facility Number: J3 —Z Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below —
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. -Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or..Drawings -
❑ Yes I N0
❑ Yes r,o
❑ Yes [�No
❑ Yes<No
❑ Yes JN�No
Rroulw>! r;s�r. .Sx <6f 6"l%/` "hcrrYt v-rare-�( �'isrr -,� pr>!veat`
1AL h,,t tµxlprrv;v_lgj Lvvea6 iv. �eloiy 8'O( W eVt v1aL pira.�-wsz -F; l� �ws
Colj,?'td it" &^a-442 larsE �der�� htl�C
-kq / C 4/ � Strn Ar daa-Ya{t gkr�UjL(G oon lil�fk��
�tct4,�� r�adr �afavyt l�d�ls-
3/23/99

13 Division of Soil and Water -Conservation Operation Renew
13 Division of Soil and Water -"Conservation Complianee Inspection
_ `� Drvision of Water Quality -Compliance Inspection
. O'Other Agency-.Operahon;Revrew _..
' Facility Number '
Date of Inspection
Time of Inspection
Q Permitted 0 Certified 0 Conditionally Certified ❑ Registered C
FarmName:.........................................................................
Owner Name: -- .
Facility Contact:
Title:
County:
Phone No:
LLLqG 24 hr. (hh:mm)
Date Last Operated: ..............
-rlk;,
Phone No:
FlailingAddress: .....................................................................................................................
Onsite Representative: �L.i�'� lSy'.. 17 Klr�........................................ Integrator:....`
...........................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=° =- Longitude =• =` =11
_ Design Current
-Swine .!. Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current = Design Current -,,_, l
dtry Capacity Population Cattle Capacity Population
Number of Lagoons ❑Subsurface Drains Present I[[] Lagoon Area ❑Spray Field Area
` Holding. Ponds / Solid Traps E� .: ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
I
Freeboard(inches): .........................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — j Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pan 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 maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN
12. Crop type
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
did vigl'atioris:oi: deficiencies •were hbted� dtWiitg this' visit. - Y:oit :will-febeipe iiti further • : -
coriespondeitce abotiti this visit: :............................ .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Use drawings of facility to bettef explain situations: (use additional pages,as necessary):
IGt..2�See`
3�
�S t i t'1 t'�t-G c✓P�S 2.V2V�/ o� cic��r-,
Reviewer/Inspector Name t-
Reviewer/Inspector Signature:
Date: 11U —
3/23/99

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 1995
Time:
Farm
Mailing Address: `i-q`
County: fly let_ 1 .J
Z o
Integrator. Phone: R to) AS — AL-3
On Site Representative: Phone:
Physical Address/Location: S 2 1811 0°g-�
S fL i 52 1-n
Type of Operation: Swine v . Poultry Cattle
Design Capacity: o Number of Animals on Site: 8 P?
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 ° 4-1 ' 3D " Longitude: '12 ° q1 ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
• (approximately 1 Foot + 7 inches) es r No Actual Freeboard: 2 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oroas any erosion observed? Yes orq0
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: CpAsrI4 L FVS(-IIt t CEO At rL'C__i
Does the facility meet SCS minimum setback criteriaQ5�Feet from Dwellings. Ye r No
100 Feet from Wells? _9%r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oC5)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o he state by man-made ditch, flushing system, or other
similar man-made devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate waste management rec ds (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop ?Yes r No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.