820721_INSPECTIONS_20171231

NORTH CAROLINA ...�
Department of Environmental Quai

Type of Visit: {-Compliance Inspection Operation Review O Structure Evaluation d Technical Assistance
Reason for Visit: tine Q Complaint O Follow-up 0 Referral O Emergency Q Other O Denies! Access
Date of Visit: L. Arrival Time: vJ Departure Time: r c=c) County: Region(
Farm Name: C/�� ✓rrr-' /c j Owner Email:
Owner Name: e ✓ y �-r�t •� I j`� /� Phone:
Mailing Address:
Physical Address:
Facility Contact: �c �[` w i 1 6 -a. --*xTitle: Phone:
Onsite Representative: integrator: '51t te 10
1 q
Certified Operator: Certification Number: C g
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Panitry Capacity Pop.
Finish Layer
Design Earrent
Cattle Capacity Pap.
DairyCow
DairyCalf
Feeder
Non -La er
o Finish
o Wean
to Feeder
to Finish
gBoars
ZfI
y 0
Design Current
D . P,oul Ca aci P,o ,
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brond Cow
Turks Faults 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 LJ`r"c' ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
0 Yes
❑ No
[SfNA
❑ NE
❑ Yes
❑ No
Q'l 1�A
❑ NE
❑ Yes
I__f l"o
❑ NA
❑ NE
[:]Yes
E T<
❑ NA
❑ NE
r
Page I of 3 21412015 Continued

Facility Number: P72 - LI Date of Inspection: .
1
Wast? Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
It
❑ Yes
E-NV—_0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 "*Jo ❑ 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
❑` ol_ ❑ 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
!� t`o ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
jDNla--❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
Q No ❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[L]'7o— ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes � ❑ 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): 67 /"{,,1 6' r'/
13. Soil Type(s): �'u i IIL 1- t 7
ti
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 F:;Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�J_`No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
E2-flo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ 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
D—No
❑ NA
❑ NE
the appropriate box.
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [3-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F(No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IFacWty Number: Y Z.- `1 Date of Inspection: /
24. Din the facility fail to calibrate waste application equipment as required by the permit?
M. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
'Yes 6 ❑ NA
REP
❑ Yes [J'1 o— ❑ NA
❑ NE
❑ NE
❑ 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 4kility fail provide documentation of an actively certified operator in charge? ❑ Yes E j No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes G]-N° ❑ 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
f 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 E]-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 �o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [2-No❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ErNo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C11-1° ❑ NA
❑ NE
Comments (refer to iieshon #) E*plain any YES answers and/or any#addmonal recommendations or o#tier comments.
to
Use drawings afifacilli better explain situations ( addEtionaltpages;as necessary,).
Cf/o- 3i)�-��5�
Reviewer/Inspector Name: t �l C►vt,
Phone:%e)— 133-333Y
Reviewer/Inspector Signature: J) (,
Date: 2z -, [
A
Page 3 of 3
.1
21412015

RS
Type of Visit: (oj Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q*outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time. Departure Time: County: Region:P_4L
Farm Name C-f .1 'I a t./t-&4, j Owner Email:
Owner Name: LA ` � Phone:
Mailing Address:
Physical Address:
Facility Contact: r V...— Title: Phone:
Onsite Representative: t f Integrator:
Certified Operator: Certification Number: �t� (� S f
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design Current
Capacity YyPop::
Design Current
Cattle Capacity P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Design: C_ tRrent `'
F
Cow
Farrow to Feeder
i) . P,oul
a aci Po :
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other.
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 �❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [::]No
C3.,Air4 ❑ NE
[3-NA ❑ NE
❑ Yes ❑ No �1A ❑ NE
❑ Yes [ io ❑ NA ❑ NE
❑ Yes tt.Yi"" ❑ NA ❑ NE
e.
Page I of 3 21412014 Continued

-mhlFacilky Number: - Date of Inspection: O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [t].Iw—C] NA ❑ NE
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
❑ Yes ❑ No [D.NA ❑ NE
Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EKo [] 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 [!TNo ❑ 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 E5No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. I-] Yes ETC ❑ 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): gLtv
-
13. Soil Type(s): _ (pa "n _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes ❑/ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E§oKo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ 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 I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[3No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ja"'N'o
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

lFacitily Number: - Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2-<o ❑ NA ❑ NE
the appropriate box(es) below,
0 Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ®<o 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [Et o ❑ NA ❑ NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes ❑v'1Qa ❑ 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 Quo ❑ NA ❑ NE
[—]Yes [a'No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [f'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to- question #): Explain any YES answers and/or any additional recommendations or any�ather,couiiirents
Use drawings of facility to Defter explain situations'.(use additional gages as necessary). A -
",b t,¢`,O,
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
15 7-o
Phone:LK3��n3y
Date: o " b
21412014

013092
Check: 13092
Date: 3/11/2015
Vendor; 47
ri
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
INVOICE
Annual Permit Fee
Ii���p�I�INNIVIV�I��Nllf
Open
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice Number: 2015PR001856 Annual Fee Period: 2015-04-14 to 2016-04-13
Permit Number: AWS820721 ;nvoice Date: 0310612015
Sampson County
Cartisle Fames Inc Due Date; 04f05n015
Larry Carlisle Annual Fee: $180.00
1555 Rolland Rd
Autryvilte. NC 2831a
Notes:
1. You may pay either by check/money order OR by electronic payment
2. If payment is by checklmoney order, please remit payment to:
NCDENR - Division of Water Resources
Attn: AnimallDischarge/Non-Discharge Billing
1617 Mail Service Center
Raleigh, NC 27699-1617
3. If payment is electronic, see hltp:llportal.ncdenr.oralweblwq/hoi-toDieslepayMent for additional details. See
htlp:l/pprrtai.nrdenr_orolwe le ayment to pay electronically. _Qnbt eCheck transactions are allowed at this time. Credit card
transactions are not accepted.
4. Please include your Permit Number and Invoice Number on all correspondence.
5. A 525.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
6. Non -Payment of this fee by the payment due date will initiate the permit revocation process.
7. Should you have any questions regarding this invoice, please Contact the Annual Administering and Compliance Fee
Coordinator at 919-807-6316,
CARLISLE FARMS INC.
VCDENR-DIV OF WATER QUALITY
L617 MAIL SERVICE CENTER
2ALEIGH, NC 27699-1617
Invoice P.O. Num.
Z015PROO1856
Permit# AWS820721
Prior
Invoice Am t Balance
180.00 180.00
180.00 .. 180.00

41qs , / I We, ls Q
(Type of Visit: J>Com fiance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: [cep Departure Time: County: Region:
Farm Name: AC, Owner Email:
Owner Name: LCL r Phone:
Mailing Address:
Physical Address:
Facility Contact: JZ �`r livi� U± St �"1� Title: Phone:
Onsite Representative: t Integrator: '17 R _�-7 f
Certified Operator: 4. t`t �C l� `� (.h/ 4 (xr"v Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
R'et P,551
La er
Design
Capacity
Current
Pap.
Cattle
IDaiTy Cow
Design Current
Capacity Pap.
Wean to Feeder
Non -La er
IDairy Calf
Feeder to Finish[Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Heifer
sl
D , P,oaltr C+a aci P.o
Layers
I Dry Cow
Non -Dairy
Beef Stocker
Gilts
Boars
Other
Other
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes
❑ No
ffNA
❑ NE
❑ Yes
❑ No
[f NA
❑ NE
d, Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No [ ` A ❑ NE
❑ Yes ET<o ❑ NA ❑ NE
[—]Yes ED�No D NA ❑ NE
Page I of 3 214112014 Continued

Fscili Number: A4 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? 0 Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑NA ❑NE
❑ No DN< ❑ NE
Structure 6
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes 2<0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes B<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E rNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failurc
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): (__Wf ')
13_ Soil Type(s): �Ci.vN
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ga"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eff"No
❑ NA
❑ NE
Records & Documents
_Required
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�J`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 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? ElYes 13No❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FacilityNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es Q No ❑ NA ❑ NE
the appropriate box(es) below.
lure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [v] o ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [r 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 E31 o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below. ❑ Yes Q'l`<o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes . is ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 3To ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes B No ❑ NA ❑ NE
Comments (refer to question {f): Explain any YES, -answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
5 � �
F , i w1. dv e IlaC-de 4 r. o+u
-F4y , V` q81 '- 07t)1
Reviewer/Inspector Name: �i� Phone: 33- 3 3
Sq
Reviewer/lnspector Signature: Date:
Page 3 of 3 214/2o 4

Type of Visit: @'Compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: (3111outine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: IIY Arrival Time: Departure Time: County: Region:
Farm Name: r'k iCG Owner Email:
Owner Name: Phone:
Mailing<Address:
0
Physical Address:
Facility Contact: �iJ t 4 P
Onsite Representative:
Certified Operator: q
Title: Phone:
Back-up Operator: Lc'vt ���� rgs _
Location of Farm:
Latitude:
Integrator: , iJ f f L(y /
Certification Number: Cl (V (y y
Certification Number: �nl lr�i
Longitude:
Design Current
e t
.. Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity Pop....,
Cattle Capacity
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
airyHeifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , PoultCi Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
TurkeyPoults
Other
Other
Discharees and Stream ImnaetS
. Is any discharge observed from any part of the operation?
❑ Yes
No
C] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Q-11A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
El"NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ETNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
KNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
C] Yes
[5'go—
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ErNo
❑ 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
[] N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
D<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
01' o'
❑ NA
❑ NE
maintenance or improvement?
1 I. 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): C. t4j
13. Soil Type(s): a,.t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3Tlo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fNNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�Io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Fl-lqo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ulo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E?'&o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes [fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

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

Type of Visit: •Compliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 9 ttoutine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �� tN! (C 6� - 1�`'L Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: DQ,V Title: ©� Phone:
Onsite Representative: Integrator:
Certified Operator:
I {
Back-up Operator: 4A V'1 V1, U
Location of Farm:
Latitude:
Certification Number:
Certification Number: 79192
Longitude:
Design Current
Design
Current -
Design Current
Swine
-+�, � ' art �� �� `
Capacity Pop �Wet,Poult11
Capacity
bt`.
Pop
Caftle: Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
t"W ,,,
-
DairyHeifer
Farrow to Wean
:
-Design
Current
Cow
Farrow to Feeder
D . i'auIt ,
Ca aei
P
Non-Dai
Farrow to Finish
Layers
113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Broad Cow
Turkeys
Other
urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[L] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
ERNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
to
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�Go
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [G]'1Qo [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes i[3 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[] Yes
a'go
❑ 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
[ 'Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
. ER-Mo
❑ 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
ZINo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[tEr'�o
❑ NA
❑ NE
maintenance or improvement?
I L 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
W
12_ Crop Type(s): G is
13_ Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes " No ❑ NA ❑ NE
L001-
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [il'NIo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes r71o [] NA ❑ NE
[:]Yes [INo ❑ NA ❑ NE
❑ Yes EBAO
❑ Yes V
[] WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lid No'
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2*No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

�-
Facili Number: Date of Inspection:
24. Did the facility fat to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus 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?
Stir - s-aH - (_3
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
to ❑ NA ❑ NE
E3,<o ❑ NA ❑ NE
❑ Yes Ero
❑ Yes [Z;,Pdo
❑ NA ❑ NE
DNA ❑ NE
❑ Yes Wio ❑ NA ❑ NE
❑ Yes [Zi o ❑ NA ❑ NE
❑ Yes Rallo ❑ NA ❑ NE
[:]Yes V;'No ❑ NA ❑ NE
❑ Yes [�fNo
❑ Yes 2No
❑ Yes [ ' o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone`. 0 l�13
Date:
21412011

IC
Type of Visit: (Wo pliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: (!Routine 0 Complaint 0 Follow-up Q Referral O Emergency 0 Other Q Denied Access
Date of Visit: M1 Arrival Time: f 0TWDeparture Time: County: q�q '� Region: Fk%
Farm Name: CI�R 1� cmv\ r'c Owner Email:
Owner Name: Q A v Phone:
Mailing Address:
Physical Address:
r
Facility Contact: UVkM ?_ % Ft CA (33rh Title: Phone: ((�� ,�,�
Onsite Representative: Z r*m E _ Integrator: (N%aP,0� 47E�W�
Certified Operator: U]pN3VA VIN3RC GAG Certification Number: I q"Site
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current -Design Cur�rentr Design Current
Swine Capacity Pop. �r Wek Pault Capacity 1'op @attle Capacity Pop.
== rY�
oFeedertoFinish
inish La er Dairy Cow
eeder Non -La er DairyCalf
inishDai Heifer
Wean ign. Cuut Cow
Feeder -D :.K.Oul Ea aci P,o Non -Dairy
Finish La ers Beef Stocker
Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys =
Other *' TurkeyPoults
Other - Other
Discharges and Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
KNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
&NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(9 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
P�No
[] NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
A

r
Facility Number: 1113ate of Inspection: 7
La
Waste Collection & Treatment
4, Is
No
storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[;)MA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier. 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
E;3%
❑ 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
&a�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
allo
❑ NA
Q NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EZONo
❑ NA
0 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
[ATNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
1 1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): `F SCU vgE QauN LAN g4 i
13. Soil Type(s): n
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes d No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [,� No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application? ❑ Yes []No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes dNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check ❑ Yes �dNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps [—]Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box -below. ❑ Yes [4No ❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No �/NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of —Inspection: -711
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [YNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &�No
the appropriate box(es) below.
Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes UNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes MINo
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?
DNA ONE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
RfNo
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
[-]Yes
[dNo
❑ NA
❑ NE
[]Yes
dNo
❑ NA
❑ NE
❑ Yes Rf No
❑ Yes [f No
[:)Yes EdNo
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explana any YES answers and/or any additional recommendations or any otlier'comments:,
Use drawings af-facility to better explain.situations (use additional pages as necessary).,...
5 UQ L". as No, DUF_ „iv :k d CC , as
ppvF �s�or- o K- �C-Es5 vt c won
co-,C
5
1(�►q 4 4 rj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ON C'N
Q�p �
Phone: 410.30X- G X +5 t
Date: —1I10 I-)
21412011

Type of Visit: m Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
10 +Sjjf It !X a m RD
Date of Visit: Arrival ime: A � Departure Time: �.C1D m County:JA►� a Region: f
Farm Name:
C01A I S jE
rAR T,2
.2,,C
Owner Name:
AAiq"
CA A l r y
I E
Owner Email:
Phone: ?/OCT67 -Cd36
Mailing Address: _155.5 �OI nf\D &AO AuiU tak A i G
Physical Address:
Facility Contact: Qqn FpallitC 0o\ Title: 03C Phone: rIIQ-W 78L.S 1c3
Onsite Representative: „ �'q� {tt (�I, f/t �� �.l frp�� Integrator: I ■yotieh
Certified Operator: _ &A41 f rA7RC,1Q,1A Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
''
�**�,�CurrenCapacity
Swore apacttZak-
Po
Wean Finish La er
airy Cow
Feeder
Non -Layer
airy Calf
Finish
'
DairyHeifer
o Wean
D
Design
Current
Cow
o Feeder D , ;1?oultrY Ca .aci Po
Non-Dai
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
q
Turkeys
--
Uther
Turkey Poults
Other
10ther
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 5Q No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JX] No
❑ Yes Do No
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[3 NA ❑NE
Page 1 of 3 21412011 Continued

41W�
Facility Number: 01 - -72 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in): l9
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes (R] No ❑ NA ❑ NE
❑ Yes M] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
a] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
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): 4415,1., )+% t m 2� 36v intAr.b3 1,���
- buFR59-tD W3-V^
P_ g&
oaf
13. Soil Type(s); ��RAI\}�P•�
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
91
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes X] No ❑ NA ❑ NE
❑ Yes (t] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
k No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
M No
❑ NA
❑ WE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps [—]Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
W No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�] No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

I IS-ll
Facili Number: 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 ` 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 1Z] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No q] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
W No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If ycs, check the appropriate box below.
❑ Yes
J@ No
❑ NA ❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes]
No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments , ` -
Usidrawings of facility to better explain situations (use additional paces as necessarv):''
jX F_gLapntCn7 C+krbR%4_run w Eev6 fo be Gone 6`i !4,311I1
Fkotr• Lik too N -7 A0)'D - p�p 3 `y 0 F4 kriv
r-910-c434-78
Reviewer/Inspector Name: L 5. SA. t io s Phone
Reviewer/Inspector Signature: `� A, Date
Page 3 of 3
t11�i1
21412011

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine ❑-Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q ` Departure Time: I 10.3Chj County: s%Q*1 PSG Region:
Farm Name:
Owner Name:
Mailing Address:
Owner Emai
Phone: i ��—
Physical Address:
Facility Contact: �h tBCttrC ��t'' Title: Phone No:
Onsite Representative:
tk
Certified Operator:
Back-up Operator:
Integrator: tJLL'p ✓ r v
Operator Certification Number: 3 ��
Back-up Certification Number:
Location of Farm: Latitude: = 0 0' =" Longitude- = 0 0 ` = "
Design
I esign C►urrent
Swine Capacity Population Wet Poultry
Capacity Population C►attle Capacity Population
❑ Wean to Finish 1 10 Layer I
I❑Dai Gow
❑Dai Calf
- ❑ DaiEX Heifer
❑ Wean to Feeder
❑ Non -Layer
El Feeder to Finish
Farrow to Wean Dry Poultry
❑ Dry Cow
Farrow to Feeder
❑
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
-Lers
Non -Layers
El Gilts ❑ona ers
El Beef Feeder
El Boars El Pullets
❑Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
Number of Structures:
❑ Other
10 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)
e. 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?
�f3
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
❑ No
I9PNA
❑ NE
PNA
❑ NE
❑ Yes
❑ No
❑ Yes
'PNo
❑ NA
❑ NE
El Yes
PNo
❑NA
❑NE
12128104 Continued

r�y Number: eg,-7
Date of Inspection 'r 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P1No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 tructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37 u
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
M No
ElNA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[,No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
09 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O 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) I-e.4 c4.e U*1aS+v,6 J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [PNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 1� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #) Explain -any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better ex A in sftuations. (use additional pages as necessary):
Reviewer/Inspector Name
_ -,3342
Reviewer/Inspector Signature: Date: 1�
Page 2 of 3 12/28/04 Continued

Facility Number: —'� Date of Inspection �0
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yicld ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[4No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[R No
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively Certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
2&
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
q0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[@ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
10 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
ElYes
[N No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection With an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B No
❑ NA
❑ NE
Page 3 of 3 12128104

Djkc UVf -713010
a H 7a
Type of Visit -&Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ��<`�S' County: `3 f
f
Farm Name: _ _ o_ Owner Email:
Owner Name: W 1 sle Phone:
Mailing Address:
Physical Address:
Region: ��
Facility Contact: -bon HOiWQA _ Title: O(C _ Phone No: , g18-w(os(C�
Onsite Representative: b1% �ir � 41 10/hL� Integrator:
1 f
Certified Operator:_ Gbllr�� lff-[ Operator Certification Number: 1931(Z�. _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o • E__1 « Longitude: 0 ° ❑ I ❑ u
Design
Curreut�urreyDesign
Ct
Desig<t Current
Swine
Capacity
Populationapacity
Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
JE1 Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
qao
H000Dry
Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish
El Layers
El Stacker
❑ Gilts
❑Non -La Non -Layers
El
El Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
❑ Turke s
Qther
❑ Other
❑ Turkey Poults
I
Number of Structures:
ther
Diseharp-es & Stream Facts
1. Is any discharge observed from any part of the operation?
❑ Yes
';'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Id No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 43a -'] , Date of Inspection n4�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5�rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Stn+cturc 2 Structure 3 Structure.; Structure Stiurturc 6
Identifier:
spillway?:
Designed Freeboard (in):
Observed Freeboard (in): OWK
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �dNo ❑ 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 N No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
%Vaste Aaotication
14. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1c 'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 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) P ff /I_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
El -No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes
`RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name S C ul✓ 1 ejZ Phone: [phone]QQ K33-V
Reviewer/Inspector Signature: 'LA'P.IL., Date: " 30 aoog�
I
Continued

-7a
Facility ;Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5 -No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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? (ieJ 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
'�3 No
❑ NA
❑ NE
❑ Yes
❑ No
Cq NA
❑ NE
❑ Yes
Z9 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ERNA ❑ NE
❑ Yes NNo ❑NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes ' 3 No ❑ NA ❑ NE
❑ Yes 97No ❑ NA ❑ NE
❑ Yes §�`No ❑ NA ❑ NE
Additional Comments and/or Drawings:
I, Irfm a }s � r� s! 6-7 , % kyor* !
CoA sfoid_ of-%scw L � m� wu,- a 1 e j�
N� =fi 1 Sec�ifr, of �e ft_ teed r w�X 00jro j j Pa)Ls 14A 4s/4 ,
ace
;t5' S f t dye n un7 ba3 VY*f 4 r ,4j wtr k�� v e rn, �' I` �? la�►n,� `f p
3t , Woq Sif, SG(ve �i le 44 or�'C ato�� POA b�-
]n� �e � I e� ,
a1i
12128104

FRO or Farm Records
Lagoon #
Top Dike 31-0
Stop Pump 49
Start Pump 4r61)
'ri=a(Mify No. 19-��)Far Name U Date 01),91 pq
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cent)
FB Drops
La oon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Slud a Surve Date
Sludge Depth ft& %
33
Liquid Trt. Zone ft
Calibration Date
Soil Test Date �}�I Crop Yield 120 min Inspections
pH Fields 5-7-0 Wettable Acres �T Weather Codes
Lime Needed O. - WUP Transfer Sheets
Lime Applied QKi Weekly Freeboard ✓ RAIN GAUGE
Cu __iI'Zn ✓ Rainfall >1° ✓ Dead box or incinerator
Needs P an*—ay.1 in Inspections
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
qp 4Y D
Verify PHONE NUMBERS and affiliations M�k� Date last WUP FRO `] JQj Date last WUP at farm App. Hardware
rJ m;1Pd ire
An-fieyf�M�ek 9�>
Sa��c�
Soil Test Date �}�I Crop Yield 120 min Inspections
pH Fields 5-7-0 Wettable Acres �T Weather Codes
Lime Needed O. - WUP Transfer Sheets
Lime Applied QKi Weekly Freeboard ✓ RAIN GAUGE
Cu __iI'Zn ✓ Rainfall >1° ✓ Dead box or incinerator
Needs P an*—ay.1 in Inspections
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
qp 4Y D
Verify PHONE NUMBERS and affiliations M�k� Date last WUP FRO `] JQj Date last WUP at farm App. Hardware
rJ m;1Pd ire
An-fieyf�M�ek 9�>
Sa��c�

Type of Visit JKCornpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q ; Departure Time: ® County: SA'tt Region:
Farm Name: l.��++ Ilr i ll i'tp Tll/ -Inc- Owner Email:
Owner Name: j}_I Phone: !
Mailing Address: i 55S I l ibd ar(�' N
Physical Address:
Facility Contact:
Title:
Onsite Representative: r
Certified Operator: Dm1d T? ( �„
Rack -up Operator:
Location of Farm:
Phone No:
Integrator: p,,,�M S�}rlr.�iteC
Operator Certification Number: AhA IU6
Back-up Certification Number:
Latitude: [::] o =]' F-1 µ Longitude: E�] o =' = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
Q Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
Q Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Un acts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current; :
Cattle Capacity Population---.
El Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
(] Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
Q NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
J'No
❑ NA
❑ NE
Page I of 3 12128104 Continued

I Facility Number: S — a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes I?No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes IN 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?
CR Yes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
IR 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
U No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ERNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) &
I - Gr
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
N No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
W No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
IRNo
❑ NA ❑ NE
18, is there a lack of properly operating; waste application equipment? ❑ Yes
WNo
❑ NA ❑ NE
��k�y
Commentsi(refer to gvestioo_ #� � EapWn any YES, answers and/orOany, re& endiations or any other comments.
Usr_awmgs5of facility to iietter:explain: situations (use `addtlaoaal pages as necessary) -�
�w-�4':'�•4i�.`�r.r, �-: .a. -_ _ _._ sue.... thaw m,:_�. '_ ._�..-���.c�" _.
Reviewer/Inspector Name 1 7MAV SCfipj 1_ Phone>� - - �`�'
Reviewer/Inspector Signature: Date: a
n..

Facility Number: a — Date of Inspection r_ ,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ja No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box.
❑ WUP [I Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5JNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
$a 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
JjNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional;Comments and/or.Drawings:
' LOJ047�dlls are craik sbwe. I n elacrj , P1eo&- bt&kcr'j41, OW *ro,j
s (a M L'kh I rI'hYJ
tf q tfa
�ew W0k f lal Is be�j dfd,-'7 Uf Al RCS, pa*re iv -1h. Jet eAvd /�7 ntj
Its,fek+�MiIle-l~, '
SiLd
y ""t bP- f c*0044bis j,.mg- a newsl Ll esvf, oea7e_ .
will ne4 ce,
p', Srrf 0008'.
Page 3 of 3 12128104

-
��
aystock
p(�ye add 4/k, re(0 �s <r �hr
la_yoa� 4 C)
Ste{ ► y� i� ayg rocel ddjo', 1,6
p-��-
��-
C1,�,� Tod - i - sa .o
P� e a
01CChfA�.e_ doiCCA �-
i�5 N
",a NOf-bO 3&cc
oee- y�
dum, 5 fef l a0o�
t1t
c"+ � 6l o�-

c6a-7a ► &(b IP
V Nuls 9r —© rQ
Vomr7 4e i M mangy?r ' lfro- - 1 e� FtMk #wl_9�n Pl(Moefj)- `(A,, 4
h,, -Ps1 q (�i-eej 4 l'�
1Vee wvrrerdy� ma�S�weH�(�a��-� c�v
U 1 J
cot 6dj Pi K we stub OJOY7 Pox ow(e
oef-
P-eea ly r-a% a) or (� Feb
Pia to 1O) rn,l(�-11�,(Ivv�'r�i ��ue6e�
s�gPly
norsf►���ayo�,
r6h jt VT s f ob
;,o
1,p(�S Icr� 06�

I/
Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 'j Arrival Time:Departure Time: I /O, ;:v.,, County: Ste' fC��✓ Region:
Farm Name: Car (t S It_ I�6wN^ S c . �� (�.%.� S (V/`Ow�e)Email:
Owner Name:Phone:
Mailing Address: � ft` A14�v, -Ito fi c D63 �
Physical Address:
Facility Contact: bannv �+ r d o I itlr.
Onsite Representative: "
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: Rtilg i u v"
Operator Certification Number. 19 3 %b
Back-up Certification Number:
Latitude: F--Ie =` =" Longitude: [=° =' [-7"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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 PNo ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
El Yes El No �NA
❑NF
❑ Yes [PNo ❑ NA
❑ NE
❑ Yes M No ❑ NA
❑ NE
12128104 Continued

Facility Number: 'qa
Date of Inspection '1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes MNo ❑ NA El NE
❑ Yes ❑ No 11 NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes FNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �3No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? VYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'M No [I 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 ❑ Yes li� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes .® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 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) tsc�4(dQ
c
13.
Soil type(s) O ter•
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
5iiNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
'7 mom
b4300 &% 6)."ks -
C
Doi
Reviewer/inspector Name Phone: W __yT 0
Reviewer/Inspector Signature: Date: %
12128104 Continued

Facility Number: — Date of Inspection /C 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M)No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �0 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f TNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
`+® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,5 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
F3No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Cd No
❑ NA
❑ NE
Additional Comments and/or Drawings:
r
12128104

ionDives"of Water Quality
Facility Number �� Q Divtseon of Soil and Water Conservation
Uther•Agency �,
s..,,.
Type of Visit Czoutine
nce Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit G 0 Complaint O Follow up o Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: � Departure Time: J County: Region�-
Farm Name: Q`1r �� SL��0.Y>'Y1S Owner Email:
} t
Owner Name: Y nl� V l .1 r Phone:
Mailing Address:
Physical Address: --
Facility Contact: _ '
Onsite Representati
Certified Operator:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = i= 46 Longitude: 0 0= 4= H
Design Current Design Current
:Swine � x•...
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Fe der to Finish
arrow to Wean
9 'Z,O
35
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer 3
❑ Non -Layer
i
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Capacity
Populatio'
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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? (lf 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 40 No ❑ NA ❑ NE
❑ Yes
❑ No
[4 NA
❑ NE
❑ Yes
❑ No
WNA
❑ NE
[4 NA
❑ NE
❑ Yes
❑ No
❑ Yes
;ANo
❑ NA
❑ NE
El Yes
ANo
El NA
❑NE
12128104 Continued

Facility Number:t DL Date of Inspection
1 J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
)� No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J$No
❑ NA El 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
Do any of the structures need maintenance or improvement?jYes
X7.
. 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
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? 1f yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) V e—lti — W Qaa
13. Soil type(s) On y-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA ❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,K No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
k No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Q_Qnk..n tX.t C) QyoLc._s `
N4ZCCj - n SZ. M. a R LmaK � 4b S-kta 4 ; !.a ever
9 r 6, C_,0 MQacA!-ed kje- l I bL rr__ Ff,- S d: rt�
Reviewer/Inspector Name S T Nit', Phone: 9 + Q 7
Reviewer/Inspector Signature: Date:
Page 2 of 121.8104 Continued

Facility Number: Date of inspection Ick I ile I 04
Re ug ired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2<10 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑ Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f J o, ❑ NA ❑ N E
❑ 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
10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
,� NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
W NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C`NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
$3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NF
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additronal;Camments and/or Drawings:
N C44 4o +(-,rtt ey
a_ 11
2-OD l�
u r
; n rf` c�a r d S
an -4 Q
one
199 --L 6-4 rr)
p.,f
lk,' eV
c) Cc, v�
i �, 4.
6e.
t:m U.5 Lr .
f'Ttace-
S l LL6 ct 5Ov uV-'_% aka - s a P tor, o ' ac- �� ; , r�z .ed Less 4avl
3 k` % 4rQ6A Vhz4kf Jul u erne ,
C_aU. 6 V CA -' ayN ipf "Xj-lC.
m4%a h �Y-orJ S 1' n--r4 p_d Il�w,, ri -�e,,r Z60 ,I
i
Page 3 of 3 12128104

Facility No. — �� I Time In oy Time Out Date �� V
Farm Name Ciax Integrator
Site Rep
No.
No.
COC Circle: Genera or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
F ' 'sh
Gilts 1 Boars
arrow — We
Others
FREEBOARD: Design
Observed
Sludge Survey fiAOQ M?
Crop Yield /
Rain Gauge V
Soil Test L i r t PLAT
Weekly Freeboard ✓
Spray/Freeboard Drop l
Weather Codes
Waste Analysis:
Date
Calibration/GPM
Waste Transfers
Rain Breaker
Daily Rainfall
120 min Inspections
Nitrogen (N)
nb4
Wettable Acres
1-in Inspections
,a 4V- l l .. o
Date Nitrogen (N)
[c7 1 0-
PulllField Soil Crop Pan Window
0
LO

Division of Water Quality 4 , K "
Facdity-Number �a 7a Q Division of Soil and Water Conservation ��
O'Other. Agency 5
Type of Visit * Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit ! Routine Q Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Vkh. Arrival Time: i''30 Departure Time: County: `JArn t�So�v Region: H2O
Farm Name: _Co,r , �, ie ���,., c In c . Owner Email:
Owner Name: c4✓r a ea._,,rS6 Fran, Lod%iGntsPhone: 611p�%
Mailing Address: / S'SS /�h I�tZ,rg _ —z. '44,t �r�1LLI ;Ile, IV C. OP3%F
Physical Address:
Facility Contact: Title:
Onsite Representative: R
Certified Operator (7a it c 01r i-
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: Qr c r•-+ t U 13a S
Operator Certification Number: �gl
Back-up Certification dumber:
Latitude: [ o [ f [= Longitude: F-1 u = ' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
FA Farrow to Wean
O
7.70
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stoekei
❑ Beef Feeder
❑ Beef Brood Co
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: ED
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 [1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[)S] No
❑ NA
❑ NE
[I Yes
[4No
[I NA
El 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?
❑ Yes
® No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): o? 0. 7 "
Observed Freeboard (in): 3 3 .r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[A 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 El NA
El 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?
l� Yes
❑ No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CO 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M-flio ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Vq No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 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) �rs�L� sin OS �"r'e�oQ f k+d fear
la�o,c• a.
Go►'N.
fl�coA.,
L�e��
r—
1 3. Soil type(s)r .—..
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
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(D No
❑ NA
❑ NE
%-
k6kyodv 6-xA E. lido
`c.fe- �an..c �r< �
oirirVrj^q
�7-gran-L
�`p
re de14C ijv e
fpb TS. �Se
Y✓'ow cli/��
>~� ��
?v c. 4*�-,
f
Reviewerllnspector Name Qrr Phone:!a ls;re -1Sy1 L•xf 73
Reviewer/Inspector Signature: Date:
I2,Q8104 Continued

17acility Number: �a — �o?/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W No ❑ NA ❑ NE
the appropirate box. .
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below_ OYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [Z) 20 Minute Inspections ❑ Monthly and 1" Rain Inspections Q"Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 50 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IN No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ONA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
BXNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
} ,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E?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
ErNo
❑ 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
K'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[]-10
❑ NA
❑ NE
Ada t`tonal_C min nts and/or Drawings: ' �1
�r2- Vc, Ms len OrcXCGF- '�a SG��S by
<.c,raQGi-ZQ,, ,_C 1'-+15,. t7oi-.�,I O.—ce WQc f-`Le- Y a4--7,.,,t b-r atr1io
12/2VO4

V
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
t Dstr of 1'i5it: d' I imc
Facifitz Number
Not O erational Below Threshold
G"ermitted L- Certified ❑ Conditionally- Certified 0 Registered Date Last Operated or above Threshold:
Farm Name: CGr% .,4 _Z114 County:
Owner ?flame: Larr.� Q i:.Ir6 if -Phone No: _ 9i0- SG % — 41JR
Mailing Address: iSS;r Hv%!z, J A/_ 4, 2,,v.Vle YL V 831IE
Facilit.• Contact:
Title:
Phone No:
Onsite Representative; �tzr1� lnterrator:
Certified Operator: fio I F rOperator Certification Number:
Location of Farm:
LBS swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a i " longitude 0 01
Design Current Design Current Design Current
SwiDt Ca acitti Population Poultry Capacity Population Cattle Ca ackv Population
❑ Wean to Feeder 10 Laver ❑ Dairy
❑ Feeder to Finish L 10 Non -Laver I ❑ Non-Dairy
Farrow- to Wean 720
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gifts
El Boars Total SSLW
Number of Lagoons
Holding Ponds 1 Solid 'Traps
W
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Laszoon ❑ Sprav Field ❑ Other
a. If discharge is obsen•ed, was the conveyancc mar -made?
b" If discharge is observed, did it reach Water of the State? (If yes, notiA, DWQ)
c" If discharge is observed. what is the estimated flow in ealltnin?
d. Does discharge bypass a Iaeoon system? (If ves, notify DWQ)
2" Is there evidence of past discharge from any part of the operation?
Area ILJ 5 rav Field Area
❑ Yes
❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection eatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Svillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 3
Identifier: r
Frceboard (incbes): 10
05IV3101
❑ Yes Do
❑ Yes [lZo
❑ Yes ErNID
❑ Yes ['Rio
❑ Yes ErNo
Structure 6
Continued

Facility Number: B.:� — 7.2 ! Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenauce/"unprovement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Arc there any buffers that need maintenatim improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive landing ❑Pik N [I Hydraulic Overload ❑ Frozen Ground El Copper and/or Zinc
H 2 ISO r�0 loft i0 Fro
12. Crop type feseve Ca/rt so,.ire.. s . " / I t✓/f , e"4' Svc
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWA
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 deterrninabon?
❑ Yes B-90
❑ Yes [mod
❑ Yes @`1 o-
❑ Yes O'N6
❑ Yes [tea
❑Yes UK&
❑ Yes 0-go-
? ❑ Yes
P-Ko
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes Ubw
Odor Usaes
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes goo
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 9-No
Air Quality representative itnmediaxely.
YtS {Beet 71�
-��. �wp�1N7� �1�77
r P 'tiT s
e _
si3dra#wrat� of lnTtty 1_ er-'-:si#uatiams( AS aea}'� reld Copy ❑Final Notes x
`r n W F� � '_'.` ..- a:•z_�z-mac -s.:: _ _ � : , .-... x-; _�� ��':��.� -��.," �'
�AG
r M/Or�•�? rs n J r�i IC. CS �d ! �,'o/Oi/C �j
..'--^... r-
Reviewer/Inspector Name./rlrf(� K
ReviewerlInspector Signature: �- Date: ! 7- liyq
12112103 Cowed

IFacility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
O'No
22. Does the ihty fail to have all components of the Certified Animal Waste Management Plan readily available?
(ieJ , checklifi[s, desigfo, nos, etc.)
❑ Yes
o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑,Pdo
❑ eades ❑ FTeeb=d ❑ Waste Analysis ❑ Seib
&-;I '- 1,7 ? ;ate 1,G
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[moo
25_ Did the facility fail to have a actively certified operator in charge?
❑ Yes
O'No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
cpti
27. Did Reviewerfl spector fail to discuss reviewrmspection with on -site representative?
❑ Yes
❑- o
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
21+10
31, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32- Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
1211'2103

LJ Division of Soil and Water Conservation 0 Other Agency &"
�a Division of Water Quality"
10 Routine O Complaint O Follow-up of DWQ ims ection O Follow-up ofDSWC review O Other
Facility Number Date of Inspection to
Time of Inspection y / 24 hr. (hh:mm)
© Registered P(Certilied f Applied for Permit [Q Permitted 113 Not Operational Date Last Operated:........... .............„
Farm Name: ,....... ,arllSl�......�ti11'IL:tL��a f?.....t-..................................... County: .............. ;!..,ol....................................
OwnerName: ...............Z4 .I. ............... ........Q!l :..e ................................... Phone No. ................... 56.r1....n.4U3.3..............
Facility Contact: ........... 8*�r ........ Title. 1... Phone No . ................
Mailing Address:............. ......ITA. :ne!i....... b. ............................ ............. r .VLI �,.... I v!..L................... I. ... 3..........
Onsite Representative:.--------------.�llpi..... ...... f�ir-Gk.4 -_ .............. .... Integrator:-- ....... .........
Certified U erator;_____...-- a+�" p ;(.�..._ .a..........r.._.........�P.................._.... Operator Certification Number..._.._..,..._....__...._.._...
Location of Farm:
0
Latitude ' =4 = 61 Longitude =- =L 46
Desigm ,Current ' " Design ' ': Current r. aDestgn CurrenU w
Capacity Papulatton Paiidtiy Capacity Pbodlation Cattle CapacityPopulakian j
e:
FODairy:on-Dairy
,.R
s;
n
n CapactyA.;
an
�R.
R
pta�°sgi.�w,'
=N"EbW f Lagoiims / Holding Eands� Subsurface Drains Present ❑Lagoon Area Spray Field Area
"
_
q No Liquid Waste Management System 3
,.
❑ Wean to Feeder
'=
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
19 No
2.
Is any discharge observed from any part of the operation?
❑ Yes
04 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 galhnin?
1�
tt+
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 Slate other than from a discharge?
❑ Yes
[�No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
b.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
14

Facility \umher
8- Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
Structures (Lagoons.11oldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Stnteture I Structure 2 Strumire 3 Structure 4 Structure 5
Structure 6
Identi tier:
eix
Freeboard(t't): ._...................... ............................. ....... ..... ............................. ............... ..................... ................................... .....................................
10. Is seepage observed from any of the structures?
D Yes
[XNo
11. Is erosion, or any ether threats to the integrity of any of the structures observed?
❑Yes
[;(\o
12.. Do any of the structures need maintenance/improvement?
,Yes
❑ No
(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?
❑ Yes
IX No
WasteApplication
14. Is there physical evidence of over application?
❑ Yes
IxNo
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ........ ...................... ... }...-:.....(�tS2q� ,a�........ .... ..... r......... .
t:TlYV t - YU)....................
I..........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[(No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
[XNo
18. Does the receiving crop need improvement? AAh r N .�
[I Yes
[(No
..o
19..Is there a lack of available waste application equipment? Q
❑ Yes
Q(No
20. Does facility require a follow-up visit by same agency? jj��
4_5 GlPtT
❑ Yes
No
21. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative.
Cl Yes
No
22. Does record keeping need improvement? /J,
Yes
El 10
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes A No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes ❑ No
0 No.violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit:
Comments{refer to c Uestion #), 'Explain any YES answers and/or any recommendations or any, other comments.° .
Use drawings Uf ficility to better explain situations. (use.additional pages as necessarjr}:
fr a� n
bye L�_ WVIA
0)1 v+%t5c
6-n aM;CA f,)A4# 01 Cove-' 94A"'
C1W OYT 7/25197
Reviewer/Inspector Name —J_e_-09:�0A_ _
I Reviewer/inspector Signature:
Date: /Q —,Qa —

State of North Carolina
Department of Environment.
Health and Natural Resources A • •
Fayetteville Regional Office
James B. Hunt, Jr„ Governor ID � H N Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL NANAGENENT
Water Quality Section
August 2, 1995
Mr. Carl Little
Dogwood Farms, Inc.
Post Office Box 49
Clinton, N.C. 28328
Subject: Concentrated Animal Feeding
Operation Inspections
Dogwood Farms, Inc. Facilities
Sampson County
Dear Mr. Little:
Thank you for interrupting your busy schedule to assist in the
inspections of the Dogwood Farms, Inc. swine facilities in Sampson
County August 1, 1995.
Attached please find a copy of the inspection forms for the
facilities visited. We ask that you forward a copy of the forms to
the appropriate growers with the thanks of this office for allowing
timely access to their farms.
Again, thank you and Mr. Brian Spell for assisting in the
inspection process. If you have questions or comments concerning
the inspections please do not hesitate to contact me at (910) 486-
1541.
Sincerely,
Paul E. Rawls
Environmental Specialist
cc: DEK Facility Assessment Unit
Wachovia &ilding. Sute 714. Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-corazner paper

Site Requires Immediate Attention: _X_
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: August 1 , JW5
Time: 12 :15
Farm NanWOwfw:
Mailing Addmss:---�
County:
Integrator: Dogwood Farms, Inc. Phone: [phone] ext 16
On Site Representative: r., r l 1_i tt1 v r Iln��nnd _Fn rmc PhoneZ 9 7 n) 592.-? i nz,
Physical Addressfl.=ation:_
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
L.atitude:10 U 04' 03 " Longitude: ° 37 '—!�C
35" Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm
(approximately I Foot + 7 inches) Yes or No 4.reeboard:�Ft. inches
Was any seepage observed from the lagoon(s)? Yu or o as any erosion observed? Yes or l6o
'1
event
Is adequate land available for Spray., Yes or No Is the cover crop adequate. Yes or No (Not Evaluated)
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin&oT
or No
100 Feet from Wells? No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No (Nor
Is animal waste discharged into water of the state by man-made ditch, flushing system, or4xher Evaluates
similar man-made devices? Yes o9:jS-9) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied4Not Evaluated)
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: This was a very breif Inapp-g-,ricm. -;3 mare rharnmigb inspeCtion Will he
conducted
in Lbe future -
Information noted on this inspection Was obtained from the intergrator
if you have questions regarding this report please contact Paul Rawls. D0_Water Quality
Section at [phone].
Inspector Name
Signature l
cc: Facility Assessment Unit Use Attachments if Needed.