760004_INSPECTIONS_20171231

+ Division of Water Resource
Facility Number ❑ Division of Soil and Water trser► ation U � L�
❑ Other Agency
'['ype of Visit: Co ipIiancc Inspection Operation Review ❑ Structure E aluation ❑ Technical Assistanee
Reason for Visit: Routine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
(late of Visit: ArrivalTime: l)cparture ['imc:L——=—�--' County: F uf't❑ b P� Rel;ion:
Farm Namc: _�_� p pp� �'1 Q-0.[� Eq r m Owner Finail:
Ocaner Name: TC, tr1 U O f e-- I Pu r \1 ► S Phone:
Z
Mailing Address: a S C1 `C SDI [? 5 � � , �c� � �� i n 5� N c
1'h►tiical Address:
Facility Contact: n V
- htQ p tr Title:
Onsite Representative:
u Phone o t 0Ja a s- 7 6 7-5
[nlegrator: P t3 r U l S ^
Certified Ope rotor: 7,0 el V Mo 0 f-p-- Certification tiumhcr:
Back-up Operator: Certification ,Number:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
�.�
r WITH#
Other
ether
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dr►• Pouliry Capacity Pon.
Layers
Non -Lavers
Pullets
Turkeys
Turkev Poults
Other
Dischart,es and Stream lmitacis
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ StrLLC[nrC ❑ Application Field ❑ Other:
a. Was the conveyance man-made`'
b. Did the discharge reach ,'►raters 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 MR)
2. Is there evidence cif 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?
Lcs ongitudc. 7 q t// l 3,51/
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy CaIf
Dairy I Ieiler
Dry Cow
Non -Dais
Bect'Sloc:l:er
Beef' Ferder
Beef' Brood Cow
[]Yes � ,No ❑ NA ❑ NE
❑Yes
❑No]NA
❑NE
❑ Yes
[] No
OVA
❑ NE
❑ Yes ❑ No
❑ Yes FZ '�i' No
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I u f '3 21412015 Continued

haciiiit►' Number: - + 71 Date of Ins ection: 77
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 Irechoard? ❑ Yes ❑ No �-,NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lclkjer Z 54a Ju- _-3 g*Twyoc,_54-e- Nrn d
spillway?:
Designed Freeboard (in):
�34 11 vu
Observed Freeboard {in}: � S %a
5. Are there any immediate threats to the integrity of any of the stnrctures obsen•ed?
❑Yes 5 No
0 NA
❑ NE(i,e.,
large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en- irunmentaI threat,
noIit'y DWR
7. Do any ofthe structures need maintenance or improvement?
❑ Yes �j No
❑ NA
❑ NF
8. Do any of'the structures lack adequate markers as required by the permit'?
❑ Yes §3 No
❑ NA
❑ N1
(not applicable to roofed pits, dry stacks, and/or wet stacks)
1). Does any part ofthe waste management system other than the waste structures require
❑ Yes �q No
❑ NA
❑ NI;
maintenance or improvement:'
Waste A > >lication
10. Are there any required bufTers, setbacks, or compliance .Alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or intprovernent'?
11. Is there evidence of incorrect land application'' Il'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 l0 lbs. ❑ 'Total Phosphorus ❑ Failure to Incorporate
,ManurclSludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of %Vied Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. S o i I *fype(s):
14. Do the receiving, crops differ from those designated in the CAWMP? ❑ Yes (0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Pq No ❑ NA ❑ NE
16. Did the lacifity laic to secure and/or operate per the irrigation design or wettable ❑ Yes No 0 NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage tier land application:'
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of'properly operating waste application equipment?
/K
❑ Yes [n No
❑ NA
❑ NI;
Required Records & Documents
19. Did the facility fail to have the Certificate of'Coveragc R: 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 [P No
❑ NA
❑ NE'
the appropriate box.
❑NVUP ❑Checklists ❑ Design ❑ 74aps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
0 Yes P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboarc ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Raini'aII ❑ 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 5j No
❑ NA
❑ NE
23. 1f'scIected, did the Facility fail to install and maimain rainbreakers on irrigation equipment'?
❑ Yes ❑ No
NA
❑ NE
Prr�■c 2 of
2/112U1 S Crj►rli►rrre d

Facihty Numl)er: - Date of inspection:
24. Did the facility fail to calibrate waste atpplication equipment as required by the permit'? ❑ Yes No ❑ NA [] NE:
25. 1s the facility out of compliance with permit conditions related to sludge? IFyes. check ❑ Yes No ❑ NA ❑ NEI
the appropriate boxes) below.
❑ Failure to complete annual sludge surrey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List stntcture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes P No ❑ NA ❑ NEi
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) ccrlilicaton? ❑YesNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes j� No ❑ NA ❑ NL
and report mortality rates that were higher than normal? `�'
29. At the time cif the inspection raid the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NEi
I 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 1� No ❑ NA ❑ NI;
permit? (i.e.. discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? [fyes, check the appropriate box be]ow. ❑ Yes RfN o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW;MP? ❑ Yes 'm No ElNA ❑ N1:
33. Did the ReviewerArispector fail to discuss review/inspection with an on -site representative'? ❑ Yes q� No ❑ NA ❑ NI
34. Does the litciIity require a hollow -up visit by the same agency'? ❑ Yes R
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES ans►cers and/or an►• additional recommendations or any other co inntents.
Use drawings of faci+yli(y to tactter explain situations (use additional) pages as necessary).
51UaC SU C ve
2-()/k y
�f
Reviewer/]nspector Name:
Reviewerllnspcctor Signature;
Page 3 oj'3
Lku,due- In aor(o.
13 Saxe �'�5-
Phone: 9ra
Date: r
21412015

Division of Water Resource
Facility Number Division of Soil and Water Conservation
Q Other Agency L
Type of Visit:
Compliance Inspection 0
Operation Review Q Structure Evaluation
o Technical Assistance
Reason for Visit:
Routine ❑ Complaint
Q Follow-up 0 Referral Q Emergency
Q Other Q Denied Access
Date of Visit: vZp Arrival'I'ime: Departure'l'ime: County: {i?��t ] Region: 021=,Q
Farm Name: bfl�Ptr Fa-+{ri'� Owner Email; 1[t'j� Lk?LP__7�0�S _4 t f. a ajlir
Owner Name: Q r 6 P r 5 Phone:
■ ,
Mailing Address:
0
Physical Address: 3 S`q ii� F r k__ (!rvo o 14L_ f V I 1 11 P-d • . 5a_o r n if e , t V L-- s;- 7 .3 i/'
V
Facility Contact: oy\ 11/ NCO j" P_ [ itle: Phone: Q : 76 -7 S
Onsite Representative: Integrator: dr U r 1/ 1 5
Certified Operator: Certification Number:
Back-up Operator
Location of Farm:
TV k;:!� 0 U5'5, e-4 3a6 - q 53 » ,33& 7 Certification Number:
latitude: 3�; CL 36 � longitude: 7� d e-f � � 3 � ►�
w4 P-aO
O } o KIL,
`T D 5- tl
L Fp r *-
0r-ve-p_ K_ 9 1 11
C9 rajae� l
46 *a- on Q
os +;P—c
P l e_q5a.VL+ W,
I I RA s
Design Current
Swine Capacity Pop.
Wean to Finish
an to Feeder
eederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Hilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
La er
Iron -La cr
Design Current
Dry Poultry Canacity Pan.
Layer-,
Non -Layers
Pullets
'1'urke s
Turkey Poults
Other
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Becf Brood Cow
Discharges and Stream Impacts
1. 1s any discharge observed from any part of the operation?
❑ Yes
[A No
❑ NA
❑ NE
❑ischarge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'! (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the cstintated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Vr No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility 1\umhrr: 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 ❑ ME
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
M 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 rail 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:
D Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NF?
❑ Yes Vj No ❑ NA ❑ NE
❑ Yes K No ❑ NA [] NE:
❑ Yes 14 No ❑ NA ❑ NI;
❑Yes V]No ❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency'? ❑ Yes
No ❑NA ❑NE
No ❑ NA ❑ NE
LAI
No ❑ NA ❑ NE
Comments (refer to question ft): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). ,
■
! 1 � r ■
+
• ► � e � ti
Reviewer/Inspector Name:
Reviewer/Inspector Signature.
Page 3 of 3
w� w ►r—
�2_
TAr
9
336)� -96
Date: q 1 �1 aZ Q Ia
21412014

Facility Number: - Date of Inspection:
%Vaste Colleetion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes �No ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Stnucture 3 Structure 4 Structure 5 Structure 6
Identifier: pa �� Z 3 L) -P
Spillway?: t
Designed Freeboard (in):
Observed Frecboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L�fNo ❑ NA ❑ NF:
(i.e., large trees, severe erosion, seepage, etc.)
G. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA- ❑ NE
waste management or closure plan? '
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or iniprovcment?
❑ Yes [ No
❑ NA
❑ NE
8. Ilo any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to rooi'ed 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 altematives 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 0 I Iydraulic 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 ❑ Iividencc of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the Facility fail to secure anchor operate per the irrigation design or wettable
acres detennination?
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
Renuired 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 ofthe CAWM11 readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes f 'No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes JZ'No
❑ Yes [&No
❑ Yes }A No
❑Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ONE
�2l . oes record keeping need improvement'' U ❑ Yes ❑ No ❑ NA ❑ NE
aste Application eekly Freeboard Waste Analysis t Soil Analysis ❑ Weather Code
Rainfall ❑Stocking Vrop Yield d120 Minute Inspections [Monthly and 1" Rainfall Inspections. 2 ludgc Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes DjrNo ❑ NA ❑ NE
23. if selected, did the facility tail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 9 NA ❑ NE
Page 2 of 3 21412014 Continued

[ Wtyli,vooy S' -4t J 11 A-1. A. i .
.kV Division of Water Resource.
}' Number ®- 0 Division of Soil and WaterC. _eryation
Q Other Agency
I'ype of %lisit: Compliance Inspection 0 Operation Re►•iew D Structure Evaluation Q 'Technical Assistance
Reason for Visit: Q Routine Q Complaint Q follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: 111hZ Arrival Timer I3eparture'I'ime: 3S Count►:PZZAAph Region: WS PQ
Farm Name: p �aL3A n'i Owner Email: t� �I("��(���(a7T� t +.
Owner Name: oot; ry' Phone: V
Mailing Address: as 5 le_d• b N C C2 7
Phvsical Address:
3 S 9!0 For 1L & r 8,Pj4- 2•, S r a y ,e. 1uC_ a 7 3 ��
Facility Contact: j p A V KkCO Vr e- Title: Phone: [ j � j 4 �
Unsite Representative:^� Integrator: c PurV 6
Certified Operator: C •rtiftcation Number:
. r iear -�
Back-up Operator: V U5 y 3 �:36 erdfication Number:
Location of }'arm: Latitude: 3,�© 35-' 3d'r' Longitude:
vwy ZZd S i-o
NO,
`To E p
L For V-
r.
i C Rd - , I $ rave
d e i V e n n rim
W+
cx-v+eAr
P e-asa"i
w i r
ad
Resign Current
Swine Capacity Pop.
Wean to Finish
Wean l to cede�
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
La cr
]Non -Layer
Design Current
Dry Pouitry Canacity Poo.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Either than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef' 13rood Cow
❑ Yes KNo ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ N F
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
W o
❑ NA
❑ NE
Page ! oj'3 21412014 Continued

Facility Number; - ❑atc of Inspection; it
Waste Collection fit 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes brNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No ❑ NA ❑ NE
�n Structure I Structure 2 Styictture 3 Structure 4 Structure 5 Structure 6
/11 Identifier: �Qy1i�� -- j } VI.irJ P
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Arc there any immediate threats to the integrity of any of the structures observed'? ❑ Yes PC —No ❑ NA ❑ NE
(i.e.. large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NI,
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, notifv DWR
7. Do any of the structures need maintenance or improvement?
Yes ❑ No
❑ NA
❑ NI;
S. Do any of the structures lack adequate markers as required by the permit?
Yes [� No
❑ NA
❑ NE,
(not applicable to roofed pits, dry stacks, andfor wet stacks)
r]�
9. Does any pail of the waste management system other than the waste structures
require ❑ Yes �] No
❑ NA
❑ NE
maintenance or improvcznent?
J�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes j j No
"`]]]""" ___
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No
❑ NA
❑ Nl"s
❑ 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 Drifi
❑ Application Outside of'Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving; crops differ from those designated in the CAWMP?
❑ Yes
10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
wyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�eo
❑ NA
❑ NI;
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Required Records & Documents
19. Did facility fiail have Certificate Coverage & Permit
Yes
N�N
NA
NE
the to the of readily available'!
❑
❑
❑
20. Does the facility Fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Cliecklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 1. Does record keeping need i tprovement? I i Yes ❑ No ❑ NA ❑ NE
❑ 'haste Applic on need
Freeboard Waste Analysis Soil Analysis Waste Transfers Weathcr Code
Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections , fonthly and i" Rainfall Inspections CSludge Surve
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (�(No [DNA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNo ❑ NA ❑ NE
11age 2 of'3 21412014 Continued

At- V-a to tr
Facility Number: - jDate of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit'? vi-1-1-
Yes ;No ❑ NA ❑ NI;
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ] Yes ❑ No ❑ NA ❑ Nl:
the appropriate box(cs) below,
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
:Van -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ Nli
27. Did the facility tail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal'?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the Facility tail to notify the Regional Office of emergency situations as required by the
pennit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
Co No
❑ NA
❑ NI:
❑ Yes
[Vo
❑ NA
❑ Nl;
❑ Yes
[ Vo
❑ NA
❑ NC
❑ Yes
JX No
❑ NA
❑ NE:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No ❑ NA ❑ NE
33. [aid the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �Io ❑ NA ❑ Nl's
34. Does the facility require a follow-up visit by the same agency'? ❑ Yes TrR'-N'❑ ❑ NA ❑ Nli
Comments (refer to question #): Explain any YES answers anti/or any additional recommendations or any other comments.
Use dra►vinus of facility' to hetter explain situations (use additional paces as necessary).
C+ fes+s Lory le-ted for 00j 5 ? r� , Ck"A
Orr -o on le'+-0-d 4� r as S
a� Slud�� survey Co"te-fe-4 Q'or c2o N ckao15 7,?01S- M II yzl��
Olt--aL"
&4414_J-4�
1
= 0. q 9 511s/1Y = 1. 6 -7
J�zols =0•l9 t�-s-NI join°I-&o- �yhIIRO /s- 5;-N
Reviewer/Inspector Natne:
Reviewer/Inspector Signature:
Page 3 of
Phone:
Date: M Z�
21412014

S3 51 s s
Division of Water Re's s
Facility Number � -; 0 Division of Soil and WatE Conservation
0 Other Agency
Type of Visit: Q Compliance Inspection 0 Operation Review 0 Structure Eva luation 0 Technical Assistance
Reason for Visit: Routine ❑ Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other ❑ Denied Access
I3ate of Visit: T . _[­ _ 1 ! Arri►al Time: Departure Time: County: �P egion: u' s
Farm Name: t1nnP�i �t a ��C m Owner Email: +-o re- .rQ7
Owner Name: �t r Phone 9 PA 7
Mailing Address: - f_ ��h i+tL f
} f {
Physical Address: 35j b Fo r V__ [ ,.L0.Y-- Mi -���Cl - --
Facility Contact: �koo (` Title: Phone:
Onsite Representative: Integrator: V fV 5
Certified Operator:
l' iI
u SScy
Cc catio
3 3 [�
Number.
53 3 3 6 Ll
Back-up Operator;
— mi - ` n
ertificatio
Number:
Location of Farm: Latitude: Longitude:'
Hl Sao 50uth, �Jc) _105 Ca6i_ Ford Q,ireeVL Kill PJ, /5� raU2j
C�i r c JP� b n r I g h- oL-(+e W_ t�5 &X\A- �k L 1 P—A,
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to I� inish
p 5
Farrow to Wean
Farrow to }ceder
Farrow to Finish
Gilts
Boars
Other
{ )thcr
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Canacitv non.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
CJther
Dischampes and Stream Impacts
1. Is any discharge observed frorn any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes M No ❑ NA ❑ N FLPI
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NI;
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence ofa past discharge from any part of the operation?
C] Yes
[5No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Na
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facility Dumber: - r Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. I f yes, is waste level into the structural Freeboard?
Structure 1 Structure 2 Structure 3
Identifier: Lotter
Spillway?:
Desi ned Freeboard {in)-
❑ Yes
0 No ❑ NA ❑ NE
7777❑"''"""" No ❑ NA ❑ NE
Structure 4 Stricture 5 Stricture 6
VJ5 P
g
Observed Freeboard (in): -� 7 f �'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �6 No [ ] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [:KNo ❑ NA ❑ NE
waste management or closure plan'?
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
S. 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) T'
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 altematives that need [a Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Na ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,Ln, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ q-
l3. Soil Type(s):
14. Do the receiving; crops diffier from those designated in the CAWMP?
❑ Yes
A No
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
14 No
❑ NA
❑ NE
16, Did the facility flit to secure and/or operate per the irrigation design or wettable
❑ Yes
K'No
D NA
❑ NI:
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ Nl;
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
WNo
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the Iacility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
]�q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JrNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. i7oes record keeping need improvement? ❑ Yes C� No ❑ NA ❑ NI's
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No X�N A ❑ NE
Page 2 of 21412014 Canlrnued

Facility Number: - I}ate of Inspection: a Q
24. laid the facility tali] to calibrate waste �plication equipment as required by the permit? ❑ Yes [�fNo ❑ NA ❑ NE
25. Is the facility out ofcomp] iance with permit conditions related to sludge? I yes, check ❑ Yes XNo ❑ 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 tail to provide documentation of an actively certified operator in charge'? ❑ Yes X No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes �§ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes r� No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern`? ❑ Yes 0 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 [DNA [] 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 R/No ❑ NA ❑ NE
El Application Field ElLagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance oi'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 WNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations (or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
R IIus� S �(us h �hLe- hale fi�
F'�sc►�� �l'�las ram- 5eecl.e[� � � , peeiQll� � 1 �2. , Y�s� �aal�� ���
_Wibra+'on r v►f`e.d to aDlS'
a 2013 51U& Surf C0VA_� let'eA Vor 1 , a► a3, !�Ue
D� ► n i n o2D A,; " -- 1 F a 1 L
Pon ea r4 l0_+eA 4 r 01 ? [ 1; f 3o f V?o l 3} U-)/
S-/ 1 �i-1 14 =
Reviewer/Inspector Name:
Reviewer/lnspcetor Signature:
Page 3 of 3
Phone:-, -j � - 6- gq
Date:— biq Q�
21412014

Facility Number ®-
9Q Division of Watert
a Division of Soil and
o Other Agency
aIConservation rtb
T►'pe of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q 'Technical Assistance
Reason for,Visit: o(Routine Q Complaint 0 Follow-up o Referral 0 Emergency a Other n Denied Access
Hate of Visit: I Arrival Time: Q® Departure Time: ali]� County: ��} Region: W SM
Farm Name: (��A>° ��(� Foxy- m Owner Email -
Owner Name: lrt? Pu r v 15 Phone: r �} $ — ZT 7
C. -73a as7
Mailing Address: � 5+ q S p le-5 2,� ��5 � r� . J
""f� 7• - i l (j
Physical Address: 34T9 10 For r 1�_� V_��_ i�►1.LAI !=d - �C �r t v F-
Facili(y Contact: Title: Phone p� 7
Onsite Representative: Integrator: Y V r V iS
Certified Operator: Certification Number:
Sack -up Operator:�`�' Viet l (a G
Certification Number:
Location ofFarm: Latitude: 3S 3. �n Longitude: "] q� 3�
7 0� E y For V Cre tin �IJL � L 4 ., 1 Q rug j
t`i ve., on rl k4 --fie, r _ae `1
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Pceder to Finish
barrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ther
1
Design Current
Vet Poultry Capacity Pop.
Layer
Non -La cr
Design Current
nr► Poultry ranarit►r Pon.
Layers
Non -Layers
Pullets
Turkeys
['Urkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part ofthe 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'?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Ileifer
Dry Cow
Non-Dal
Beef' Stocker
Bect• Feeder
Beef Brood Cow
❑ Yes 4 No ❑ NA ❑ NI;
❑ Yes ❑ No ❑ NA ❑ NI:
❑ Yes ❑ No ❑ NA ❑ NI;
❑ Yes
❑ No
[] NA
❑ Nl:i
❑Yes
�No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE -
Page 1 of 3 21417011 Continued

Facility Number: - Date of Inspection; J-3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage phas heavy rainfall) less than adequate? ❑ Yes j�j No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard'? ❑ Yes 7❑'� No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LQjp_tiLI" JY 2 e' OU =2.5 PIUV.,
Spillway?:
Designed Freeboard (in): rr AA
Observed Freeboard (in): 1 V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures tin -site which are not properly addressed and/or managed through a ❑ Yes E� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable tip roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes t>r°►' No ❑ NA ❑ NE
maintenance or improvement?
►i'aste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
11. 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 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;K No
❑ NA
❑ NE
15. Does the receiving crop and/or land :application site need improvement?
Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
® No
❑ NA
❑ NE
acres detennination?
TQ
17. Does the facility lack adequate acreage for land application'?
❑ Yes
2No
❑ NA
❑ NE
l S. is there a lack of properly operating waste :application equipment?
C] Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility Fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. I3oes the litciIity rail to have all components of the CAWM1' readily available'? If yes, check
❑ Yes
'XNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Check lists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. es record keeping need improvement? t" ❑ Yes DdNo NA ❑ NE
aste Application Woop
cckly Freeboard Waste Analysis �il Analysis Weather Code
g'RJainfall Stocking Yield 5V 1120 Minute Inspections 9Monthly and l" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes ❑ No 9 NA ❑ Nli
Page 2 of 3 21412011 Continued

Facilit • Number: Date of Inspection:T1 613
24• Did the facility fail to calibrate was 1 lication equipment as required by the permit? ❑ Yes Qq 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(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
I?kbn-compliant sludge levels in any lagoon GrJWc' .� P.
List structure(,) and date of First survey indicating non-compliance:
26. Did the facility tail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility flail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ Nl:
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If ycs, contact a regional Air [duality representative immediately.
30. Did the facility fail to notify the Regional Office ol'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? I ycs, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ LagoonlStorage Pond ❑ Other:
32. Were any additional problems noted which cause non compliance of the permit or CAWMP? ❑ Yes [ No ❑ NA ❑ Nl"s
33. Did the Reviewer/Inspector fail to discuss review/inspection with an ❑n-site representative? ❑ Yes N No ❑ NA ❑ Nl3
34. Does the facility require a follow-up visit by the same agency? ❑ Yes CAN❑ ❑ NA ❑ Nli
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Ilse drawings of facility to better explain situations (use additiona
1AM004 necessary).
v�s��� tin rv►o 1.�:+uL�' }re e5 C i-+ �f�?i4 l i h c re� ood co. tt er-
b
3 Mar l� s +ro ► ktev e � r ��. cry r �5o
F1 us h is_rt k_ o-V wS — look VP_i,re_A ?
O'A
P
I Stepp 1 y hoSer ova reel faced 7 e 40
kq ..W'i brGL`h 3 0131j,
rve-k{S ? �Ci[3
3 ► 9�1 sl �g113 07,4,� t�l�lJ+� = p.q9
Reviewer/Inspector Name: iw� ei ,i spoL
In
ReviewcrlInspector Signature:
e-b oCV-,
Page 3 olj•3 � r } s 1 j � � . � 7 �j 7 / j 7 - of 7 a ;L 1. ?
Phone: 7 -7 1 - S agg
Date: go t
2.4/2011

Division of Wao Quality
Facility Number ®- ❑ Division of Soil and Water 10servation 1 �Z ,3 4 P"7
❑ Other Agency
'i'►'pe of Visit: F Co pliance Inspection ❑ Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit. 0 Routine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergenc►• ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: ; b0 Departure 'Time:— Q Countr•: Rando l hR,,ion: W SRO
Harm ~lame: �0�212 �trhe_a..d_ Fo_rf'l Owner Email: OL 01 M0d3re rA'ma -V
Owner Name: -Torl Al pp r e- EL) r~ V I v Phone: � � � t`7 � � !S � a cl 7 Ks 7
Mailing Address: S/� 1 e$ /�[� • � �O �j19 r h S Z NC Z 7 3 o; 5r
Ph►•sical Address: .5 J q l� For I-- t!, rye Ic- I [ I P-d • SQ a C rp Lf t'_ , lV C- ;1- 7 3 U
.r n
Facility Contact: Cl r, lq i f G U r-e- Title: Phone: R 7 ~- 76 I t
Onsite Representative:
Certified Operator: r }
Back-up Operator: VJL [
location of Farm:
Integrator: _ U rV ". 5 -_
Certification Number:
Certification Number:
Latitude:_ (9 _T_ 35 3 D Longitude: 7 � V / 35~
HV.
u rI V`� bIl
r I, Olf'T-�tr
��� Q�►'1�
�y�j f ►`C�
Swine
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
'
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Canneity Pnn.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharzes and Stream Impacts
1. 1s 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 ycs, 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?
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dair
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes XNo ❑ NA ❑ N1's
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NI;
❑ Yes
❑ No
❑ NA
❑ N1;
❑ Yes
P<No
❑ NA
❑ NI:
❑ Yes
JXNo
❑ NA
❑ N1
Page 1 of 3 21412011 Continued

facility -lumber: - ❑Ll Date of Inspection:
" aste Collection & 'I reatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a• Ifycs, is waste level into the structural freeboard?
❑ Yes
❑ Yes
�0-&ell
[XNo ❑ NA ❑ NE
❑No ❑NA ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 66-.>-`AI :? 9-3 ) :
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes WNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which ;ire not properly addressed and/or managed through a ❑ Yes o ❑ NA ❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7, Do any of the structures need maintenance or improvement'? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? Yes No ❑ NA ❑ N1"s
(not applicable to roofed pits, dry stacks, and/or wet stacks) it
9. Does any part of the waste management system other than the waste structures require [� Yes No ❑ NA ❑ NE;
maintenance or improvement? T"
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes
o ❑ NA ❑ NI"s
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 > l0°/n or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13.
Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
9Yes
77❑�� No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equiptncnt?
❑ Yes
�fNo
❑ NA
❑ NE?
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Pennit readily available?
❑ Yes
[XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAW M11 readily available? If yes, check
❑ Yes
SeNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. oes record keeping newyl`e
rovement? wry-ei3esl es No ❑ NA ❑ NE
Waste Applicationekly Freeboard Vasle Analysis Soil Analysis Waste Transfers Bather Code
Ed Rainfall ❑ Stocking Crop YicId 20 Minute Inspections Monthly :and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment? ❑ Yes [�' No ❑ NA ❑ NE
Page 2 of 2/4/2011 Continued
Mo sfi f� -r t 0111 j t r* - 5- L)9-s. N11o00 �

Facility Number: :7 jDate of Inspection: j3 6EFa0l,
24, Did the facility fail to calibrate waste app tion equipment as required by the permit`? ❑ Yes DNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 'WNo ❑ NA ❑ NE
the appropriate boxes) 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 9 No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q�No ❑ NA ❑ NE
and report mortality rates that were higher than normal? KNo
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ NA ❑ NE
if yes, contact a regional Air Quality representative imrnediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes o ❑ NA ❑ NE
permit'? (i.e., discharge, freeboard problems, over -application) TTTTTT'''"'
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-corpHance of the permit or CAWMP? ❑ Yes O No ❑ NA ❑ NE
33. Did the Reviewer/Inspector /ail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a hallow -up visit by the same agency? ❑ Yes �Nn ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary),
C49a b rc-jan e G�nti(�� c f �cl ? U.Q. 3 -
a [ w.,--QPx
-
---�-e�
�j
Sorge L Dor g— on, yv,::5 U_>INN
Reviewer/]nspector Name:
Reviewer/]nspector Signature: � CJ�J Date:
Page 3 of 3 pp, I k 1:1 V_iyi e ►e1d5 n � ['I Ke pet- 50 t
y

II., Y4 Division of Water Quality
Facility Number ']� -ICJ Division of Soil and Water iservation
Q Other Agency 11
Type of Visit: � Compliance Inspection Q Operation ReviewQ Structure F -valuation Q Technical Assistance I
Reason for Visit: dRoutine Q Complaint ❑ Follow-up 0 Referral Q F mcraency p Other p Denied Access
Date of Visit: Arrival Time: Departure Time: ,M.+ County: i, Region:
Farm Name: 6--v &,r ke�d *F�.+ m Own r Email:
❑AL, Moore A,ro;,s,70—Owner rame:Phone: %910),G 2.2—Z zs
Mailing Address: e J • 4 Ko lj 1 , r1 s K) G 27 3z .
Physical Address: -35�9 e� 'Fa r k 6,ruk ' l J I 9 5E kq rove— ve— W C• 27 3 L'
Facility Contact: _ MCd t� 1 itic: Phone:
_?� `317 6 7.5
Onsite Representative: Integrator: t,t r d is _ -,-
Certified Operator: F Certification Number:
Back-up Operator: �)_a51y -ill I Gym - Certification Number:
Location of Harm: Latitude: S n 3� N e , S N
3a Longitude: %� 4I 3
�.. yrtii L- `0 ..]. C r l 0 S E,, f d rk C..+f' ! M i Ir f ? •, I-QI ► o el dr+_ d A t-
L-I-
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Q 27r7�
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Other
Other
Design Current
Wet Poultry Capacity Pop.
FNc
er
n-La er
Design Current
Dr►• Poultry Canacit►• Pon.
l.a ers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge obsmed 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 I}WQ)
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
[)airy__] leifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes N No ❑ NA ❑ NE
❑Ycs [:]No ❑NA []NE
❑Yes ❑No ❑NA ONE
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 oi'a past discharge from any pan of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NI-1
of the State other than from a discharge?
flage I of 3 21412011 Continued

Facility Number: jDate of Inspection-.
Waste Collection & 'Treatment eyes
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ N❑ ❑ NA ❑NE
a. ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 II Structure 3 Structure 4 Structure 5 Structure 6
Lin nVia � '54,1�3ed
1F
Spillway?: —
Designed Freeboard (in): _
�� ...
Observed Freeboard (in): �j �] b
5. Arc there any immediate threats to the integrity of any of the structures observed? ❑ YesP/No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the stntctures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
1k qL
S. 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) 10
9. Does any part of the waste management system other than the waste structures require ❑ Yes %%%%"'CCCC"'' � No [] NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there: any required buf'f'ers, setbacks, or compliance altematives 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 k 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 [tare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop 3 ype(s): `� jc t, e- J-� + p4.j
� f
13. Soi l Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [I No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fhiI to have all components of the CAWMP readily available? 1fyes, check
❑ Yes No
❑ NA
❑ NE
the appropriate: box.
❑ WUP ❑Chcckiists ❑ Dcsign ❑ Maps ❑Lease Agreements
❑Other;
21. Does record keeping need improvement?.
❑ Yes No
❑ NA
❑ NE
�aste Application [> Icckly Freeboard �astc Analysis oil Analysis
aste Transfers
[+Weather
Code
ainfiall Stocking Crop Yield ] 20 Minute Inspections fonthly and 1" Rainfall Inspections udge Survey
22. Did the facility fail to install and maintain a rain gauge`!
❑ Yes kr,40
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
A NA
❑ NE
Page 2 of 3
2144122011 Continued

Facility Number: Date of Inspection:
f
24. Did the facility fail to calibrate waste app ration 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
A No ❑ NA ❑ NE
the appropriate boxes) 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 tucility fail provide documentation of all actively certified operator in charge?
❑ Yes
j No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
"```
No ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of'dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i,c., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 theility require a follow-up visit by the same agency?
❑ Yes
WNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7, �Qq a-d ►� � �� #-S �-- # 1 (1 �C�.� M�'7+...f Ms� � >�i'6 � [��� I.,1ec.�i� 'T� �'4-�Gi .
J / I -� .j J
1W, ,�;P r t� &J,r�reA �itic-G cJ Mtn �. �� j! r
' s! "le,eLtT4 'G
7/,z1o, 1.7
Reviewer/Inspector Name: / 7�'r �!( r'i-� C I Phone:
Reviewer/Inspector Signature: ��^ Date:
Page 3 nf'3 21412011

Division of Water Quality
Facility Number Division of Soil and Water Conservation
Q Other Agency
Type of Visit (P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit � Routlne O Complaint O Follow up O Referral O Emergency O Dther ❑ Denied Access
Date of Visit: Q Arrival Time: Dcparture'l'ime: County: Kana Region: LAZ90
Farm Name: RL r `-'—' Owner Email;
Owner Dame: r V 1,5 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: ,I a Sh W 0. U0L C -P_ Back-up Certification Number:
11
Location of Farm: Latitude: [� �T [M 41 Longitude: o FU 1 L
a -a a S b h, l `� o S Lai + I r e. f�-f o r>ato F6 r-ee.�--
Vk M I St d r i v e of -- e.r P �ect,5ar\.t lei t �d
Swine
Design Current . Q Iyesign Current
Capacity Population Wet Poultry Capacity Population
❑ La er
M
❑ Non -La et
❑
Wean to Finish
El
Wean to Feeder
I -ceder to Finish
10
El
Farrow to Wean
❑
]'arrow to Feeder
❑
]'arrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poa11s
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
I)ai ry Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beel' Brood Cow
Number of Structures: t
b. Did the discharge reach waters of the State'? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
V(N❑
❑ NA
❑ NE
❑ Yes
❑ N❑
❑ NA
WNE
12128104 Continued CIA

Facility Number; — Date of Inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NIs
a. If yes, is waste level into the structural freeboard'? ❑ Yes ❑ No ❑ NA ❑ NE
�D Structure I Structure
.,[2_ Structure 3 Struct ey,4 f _D Structure 5 Structure 6
]denti er: i Lo W 9 oZ 5 10. # sY
Spillway?;
Designed Freeboard (in):
Observed Freeboard (in): a —30
5. Are there any immediate threats to the integrity ol'any of the structures observed? ❑ Yes KNo ElNA ❑ Nfi(ie/ large trees. severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X No ElNA ❑ NE
S. 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?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Ileavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of'Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o El NA
❑ NI'
15.
Does the receiving crop anchor land application site need improvement`?
ElYcso
❑ NA
❑ NI's
16.
Did the facility f til to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yeset
❑ NA
IN
ElNI's
17.
Does the facility lack adequate acreage for land application?
ElYeso
❑ NA
[INl;
l8.
Is there a lack of properly operating waste application equipment?
❑ Yeso
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other com CntS.
Use drawings of facility to better explain situations. (use additional pales as necessary):
On Sep -LA - 0
V3.Iyl a Vey bQCk �0 r
e
AL�'�.in��S
ReviewerAnspector Name Phone:
Revie►►er/Inspector Signature: Date: U
12128104 Continued

`Facility Number: , — Q Ote of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �?No
No ❑ NA ❑ Nli
20. Does the fcility fail to have aH components ofthe CAWMP readily avaiiable? Efyes, check ❑ Yes ❑ NA ❑ NEi
the appropriate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Doc record keeping need in�rovement? , , ❑ Yes No ❑ NA ❑ NEi
�VRainfall
aste Appli tion ® Z7rop
ly Freeboard Waste Analysis SVmn)nt
alysis Wastc TransfersHNAEI
n
Stocking Yield 120 Minute Inspectionshly and 1" Rain Inspectio2No
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes:
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑.No VIA ❑ N1;
24. Did the facility tail to calibrate waste application equipment as required by the permit? ❑ Yes *o ❑ NA ❑ N1;
25. 1)id the facility tail 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 ❑ NA ❑ NI
(hher Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (No
El NA ElNE
29. Did the facility rail to properly dispose of dead animals within 24 hours anchor document El Yes El NA ❑ N1:
and report the mortality rates that were higher than normal?
30. At the time of the inspection slid the facility poise an odor or air duality concern? ❑ Yes Wo ElNA ElNE:
Ifyes, contact a regional Air Quality representative immediately
3 1 . Did the facility fail to notify the regional office ofemergency situations as required by ❑ Yes jNo ❑ NA ❑ NE
General Pennit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/hispector fail to discuss review/inspection with an on -site representative? ❑ Yes No El NA El NEi
33. Does facility require a follow -tip visit by same agency? ❑ Yes No ❑ NA [] NE:
Additional Comments and/or Drawings:
5("4 5 f ud�e 5 u r v r t 7' r� a- `11 3
1'age 3 of 3 12128104

ti
i►�ision of Water duality
i FaCiiity Dumber AM
PIL
Di►ision of Soil and !Pater Cnnseryatiun Q _�
1 ......Q Other Agency r
F
peof Visit Compliance Inspection Q Operation Review Q Structure Evaluation Q Technics! Assistance
ason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Bate of Visit: lkrri►al'Fime: Departure "rime: County: Region: 05 P0
Farm Name: f -;r��7ppex jaA Far -PI Owner Email: — _v
Owner Name: in rxLt Iyl do re r Phone: 2 a
:flailing Address:
Physical Address:
Facility Contact: TokAu 1 coot Title:
Onsite Representative:
Certified Operator:
Rack -up Operator: ,To s -)(a e
ro ve 73V-I
hone No: 1 V cqS — 74L77T
Integrator; I iJ ry 15 7
Operator Certification Number:
Rack -up Certification Number:
r--= 6o
Location of Farm: latitude: Longitude: Lj-
aaO 50 0` 41 y 7as � asf Le PV o n it ro r [C 4
sf Q r"d (�.r�v� art r'k q ��� 1� �� 1. 1 �
Design Current
swine Capacity Population
❑
Wcan to Finish
El
Wean to Feeder
Feeder to Finish
Farrow to Wean
❑
}"arrow• to feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
_. J
Design Current
Wet Poultry Capacity Population
❑ Laver
❑ Non -laver
Dry Poultry
Lavers
Non -Layers
Pullets T
Turkeys
Turkey Poults
Other
Discharees & Stream Imparts
i. Is arty discharge observed from any pan 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 I Leifer
❑
1)ry Cow
❑
Non-Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: F4I
b. Did the discharge reach waters. of the State'? (II'yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the Haste management system? (11'yes, notify ❑WQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes )No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[:]Yes
❑ No
❑ Yes
ElNA
❑ NE
❑ YesrN
❑ NA
❑ NE
12.128104 Continued

Facility Number: —] — � � Date of Inspection
Waste Collection & Treatment
4. ]s storage capacity [structural plus stortn 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:
�7 Structure l Structure 2 Structurc 3 Structure 4 Structure 5 Structure 6
I Identifier:W } w #t� V
Spillway".
Designeil l7 rceboard (in)-.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity ❑f any of the structures observed? ❑ Yes 1,No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
C. Are there structures on -site which are not properly addressed and/or managed ❑ Yes T' No ElNA ❑ NE
through a waste management or closure plan?
If an)- of (Iuesdons 4-6 were ans►►ered yes, and the situation poses an immediate public health or environmental threat, notify DNN'Q
7. Do any of the strictures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes teNo ❑ NA ❑ NE
(Nut 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 J "o ❑ NA ❑ NE
maintenance or improvement?
Waste,Ayolicaliun
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes VNo
a'❑ NA ❑ Nf:mairitenance/improvenicnt?
11, 1s there evidence of incorrect 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 Windos , ❑ E►'idence of Vti'ind 13riit ❑Application outside of Area
12, Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
_b�<o
❑ NA
❑ NE
15.
Does the receiving crap and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
10.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Ye,:
X No
❑ NA
❑ Nl.
17.
Does the f icility lack adequate acreage fir land application'?
❑ Yeti
t�No
❑ NA
❑ N1.
18.
is there a lack of properly operating waste application equipment?
Pq Yes
❑ No
❑ NA
❑ NE
Comment~ (refer to question #): Explain any YES answers and/or any recommendations or any rather comments.
llsawing% uftiacility to better explain situations. (use additional pages as necessary):
IRe►•iewerllnspector Maine J��Q i t r� ]� V_o� _ _ Phone:22 I
Re►•ic%►erllnspector Signature: _.�_. _�_ _-- �]I k A,� . Date: '3' 0 Q9

Facility Number: 7 —[} of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'! ❑ Yes ❑ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ Wi1P El Checklists El Design El Maps El Other
21. VWaste
ecord keeping nee�rW�e�e(y
ovement? If yes, the k the appropriate box Blow. ❑ Yes ❑ ❑ NA ❑ NE
Applicati f Freeboard Waste Analysis � it A tysis L+1 Waste Transfers❑d Rainfall Stocking rop Yield Freeboard)
Minute Inspections Monthly and 1" Rain Inspections eather 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 minbreakers on irrigation equipment?
❑ Yes
❑ No
9NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
o
❑ 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
❑ 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
No
❑ NA
❑ NE
32.
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
OfNo
❑ NA
❑ NE
31
Does facility require a follow-up visit by same agency?
❑ Yes
4No
❑ NA
❑ NE
Additional Comments and/or Drav�ings:
` aye F
i
• I. w �,� f ij t 1 /l /f � �y. �
r*
y fi � 1 �� i ■ ,� a / � ,l f � / � � � �. , , 7 l
I
12128104

Facility Numher
tvision of Water Qu.alioq
Division of Soil and Water
❑ Other Agency
tion
Type of Visit
Compliance Inspection
D Operation Review Q Structure Evaluation
0 Technical Assistance
Reason for Visit
4Routine 0 Complaint
Q Follow up Q Referral Q Emergency
Q Other ❑ Denied Access
ll>itc of Visit:
Arrival Time:
Departure Time: r a County:P.S&1106Region:
�LJJ tJ
Farm Name: �1C34�1?��
jk.!I ]I rd r ► �
Owner Email:
Owner Name: kgty)c
' 1`U s" filar]
Phone: 91
d f r 19 a d D e-1
Mailing Address: a
0 5 D ie- }it �
L� _ PC b t ttj , I') (—
Physical Address:
�fnIL--c eP j—
— rut,( [� � `:
cQroy �' , ��- � - t
Facility Contact: �nr\
^
It [ �,` 1r-sor•e—
'Title:
Phone No: l��0 -P sRy"Ir A.
Onsite Representative:
�M p
_ _ Integrator:
}'� L: r V 'S
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 1 Longitude: pi o
Uat��=
6�A I (1 0 - I �>�_ Q ca h+ lq� I I V14
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑
Wean to Finish
❑
Wean to Feeder
150
Feeder to Finish
[�
El
Farrow to Wean
❑
I�arrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Tun e-
Dry Poultry
❑
La ers
❑
Non -Lavers
❑
Pullets
❑
Turkevs
❑
Turkev Poults
❑
Other
Resign:.` Current.,:
Cattle Capacity, Population`-1. .
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Bect'Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of. Structures:
❑ischarees A Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NH
Discharge originated at: ElStructure ElApplication Field ❑ Other
Was the conveyance man-made'?
e4l.
❑ Yes
❑ No
❑ NA
❑a. NI:
l],� b. 1)id the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
El No
[I NA
El NE
110 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)
❑ Ycs
❑ No
❑ NA
❑ ME-
2. Is there evidence of a past discharge: from any part of the operation?
❑ Yes
No
❑ NA
❑ Nl:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
El NA
❑ NH
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Itiunther: — Date of Inspection 1 1
LU
Waste Collection & Treatment
4. Is storage capacity (structural plus stornt storage plus heavy rainfall) less than adequate? ❑ Ycs No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA El NE
Structure 1 Structure 2 Structure 3 St cture 4 Structure 5 Structure 6
/Identifier: d I Lniooar t 1 t" /1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): qe
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
o ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
�"
L
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
XrYes
❑ 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
o ❑ NA ❑ NE
maintenance or intprovenicnt?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) 04�_
I
13. Soil type(s)
14. Do the receiving crops lifter from those designated in the CAWMP?
❑ Yes
No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the tacility lack adequate acreage for land application"
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question 4): 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):
� , Iv � tYl�� 'U
�■
�•�
k� P
4
,•
Reviewer/Inspector Name I
Revie►rerlInspector Signature:
� Phone:
Date:
Page 2 of 3 v ■ 1. V • 12128104 ' Continued

Facility Number: O Mute of InspectionE;UW 10
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 KNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Doe record keeping need irnpr •ement? ❑ Yes ❑ No ❑ NA ❑FP N1?
ste Application eek Freeboard Waste Analysis S�Zthly
sis Waste Transfers
PP Y Y ,,.., f
R:rinf'all ❑ Stocking Crop Yield 120 Minute Inspections and i" Rain Inspections �' thcrCode
22. Did (lie facility fail to instal] and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. ]f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No �NA ❑ NE
24. [aid the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes .I No ❑ NA ❑ NE
25. Did the facility thiI to conduct a sludge survey as required by [lie 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 tail to secure a phosphorus loss assessment {PLAT} certification'? ❑ Yes No ❑ NA ❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ NA ❑ NE?
29. Did the Facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE"s
and report the mortality rates that were higher than normal?
30. At the tirne of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE"s
If yes, contact a regional Air Qtutlity representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NL
General Permit? (ie/ discharge, freeboard problers, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ Nl"s
33. Does fiacility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ Nl?
Additional Comments and/or Drawings:
a{ . 2JL]-�
c�� c
1 , 1 4 L �► r �,
r
lid
r
� � J� r �■ A rumi

=aeffityumber
LJ
P Division of Water Quality]
Q Division of Soil and Water
Q Other Agency
servation 1 i
Type of Visit Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit (YRoutine O Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: t Arrival Time: � Dcparture'1'ime: FIJ i7 0 1 county;
Farm Dame: 17A irOwner Email -
Owner Name:More-r Phone9
Mailing Address: 2 S�'-t 5 f] 1 r' S P06J i
,)S
Region: LLL0
-a
Physical Address:
` �o I-
Facility Contact: '` r f itle: Phone � �� �• �76 7�
Onsite Representative: l bij'11J1 Mcore _ Integrator: P U r v I
Certified Operator: 1 C7M m1.ve — _ Operator Certification Number: _0
Back-up Operator:
Back-up Certification lumber:
Locationof Farm: Latitude: ® Longitude:
a.
U •I P_01d 5o0 rotb1 S o • asf- an ti)C. i -705
Le_q� orAl_ Forl-- Le e; - M,i P3. +st Qra&iel Jrtve- Oil) righ-f
Swine
e%ign Current Design Current
parity Population Wei Poultry Capacity Population
❑ Layer
❑ Non -Laver
❑
Wcan to ' i ish
El
wean to Feeder
Feeder to Finish
I SWEa
LJ
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts.
❑
Boars
Other
❑ Other
Dry Poultry
Non-L
Puliets
IJ Turkey Poults
❑ Other
Discharue%& Stream Impacts
1. Is any discharge observed from airy part ol'the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made"
Resign Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dai Ileifei
❑
Dry Co►ti•
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cow
b, Did the discharge reach waters of the State? (if ycs, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: [A]
d. Does discharge bypass. the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the. Waters of the State
other than from a discharge.?
❑ Yes qNo ❑ NA ❑ NI;
❑ Yes
❑ No
❑ NA
❑ NH
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NEL
❑Yes
❑No
❑ Yes
No
[INA
El NE,
❑ Yes
No
I
ElNA
❑ ;11;
12128104
Continued

Facility Nuntttcr: Q mate of Inspection
Waste Collection & 'Treatment 4a
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4No ❑ NA ❑ NE;
f a. if yes, is waste level into the structural freeboard? ❑ Ycs ❑111 No ❑ NA ❑ Nl;
_ Lit Structure l 1�St^r�uctture 2 Structure 3 S tc ore 4 Structure 5 Structure 6
O 1 :Iltlfier: � ` Lo. � AO` V PCB
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in);
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 -silt which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation pases 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. Arc 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 r
o El NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload ElFroTeln Ground El leavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window• ❑ Evidence of Wind Drift ❑ Application Outside of Area
•
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement`?
El Yes
*No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'? Yes
[:]No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
/❑`Yes
No
❑ NA
❑ NE
I8. is there a lack of properly operating waste application equipment?
PeYes
1❑ No
❑ NA
❑ NE
Continents (refer to question #): Explain any YKS answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
��.rr►nod �. o r VP.6G� e.?
6 5 C u t rat 5?VLOup �-�$
Reviewer/Inspector Natne
Phone: —
R er/Inspector Signature.
bate: Q
6 12128104 Coirri►rue

0 46
FaciIit►• Number: Date of Inspection 7
Reuuired Records & Documents
19. Did the Facility fail to have Certificate of Coverage &: Permit readily available? ❑ Yes n�N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check El Yes Lb No ❑ NA ❑ NF
the appropirate box,
El WUP ❑Checklists El Design [I Maps El Other
21. Doe record keeping needZimovement? if . , e appropria c ox ow. ❑ Yes Nn ❑ NA ❑ NE
WWaste Applicati tt Lc Freeboard Waste Analysis soil A alysis4Ann l Certification
[�dRainfall 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
N
El NA
❑ Nl;
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L'J No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
❑ Na
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit? :�01
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility sail to have an actively ccrtitied operator in charge'?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure; a phosphorus loss assessment (PI (PAT) certification?
ElYes
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
❑ NI:
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the Facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32,
Did Reviewer/[nspector rail to discuss review/inspection with ail on -site representative`!
❑ Yes
No
❑ NA
❑ NE
33.
Doc;s facility require a hollow -up visit by same agency? L12L
❑ Yeti
No
❑ NA
❑ NF
Additional Comments and/or Drawings:
a 7 Ca►���-+e.d �t 1 ash o r�
� �
�'
d-()Qrq_+*bra
�'�GC]_ ? 00-7
1e+1 db
�� Cyr � �►CQ��or1 �r
�b�+� ? � .
o
JS flu 3e due or, aa3�Gn� a � ��.hol 6 f c�
e.t"Llk,
�e
3 f rs` v 7 41,3
tiJ 06k ar al
�7)
n U 12128104 —too
r� 1 I Pit Q7 vh�A t joV V_I m,

I Nis o 4:Wa( A R
P3
Water Uouser, of Soiri6a-, vition ."V", ins unit Fiii1it
Vi
Maw
- _= - ". _7 7J. - - -, . I 1 .41 W _;11_111rl�rj
ENR
Type of Visit 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical AssistanceN IZO07
j I
Reason for Visit Poutine OComplaint OFollow up OReferral OEmergency 00ther El Denied Access
rkuw1wil"k -1-11
Art-k-al County: A06�___ Region:___
Date of Visit- ibe_ Departure Fj !/7-1
Farm Name: FOW tier Email:
Owner Name: AMC- Phon
Mailing Address.
Physical Address
Facility Contact- Phone No:
Onsite Representative: AL Integrator;
Certified Operator: ............ ....... ___--- Operator Certification Nunjhcr:
Rack -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 5U 0 a] I Nil 11 Longitude: Falo[Ell 10"
2_Zz) 150ul-e yo YWY �b -go mt;7 fa A>xe ewzex ovz*_4 A,, f4v4jtoF-, ;*i* fr(37-
96w ovio mhv&_Ae2,_,c- sr-,*k f,4eeh,#vr //
Design C urrent Design Current 'Design Current -
Wet Poultry -Cattle,--
C "Capacity yqpui�tlon . C Capa ity' Population Capacity, Popubition'
apac
IE:]Wean
to Finish
I
I
El
Wean to Feeder
X
Feeder to Vinish
I 2o,257
El
Farrow to Wean
El
Farrow to Feeder
El
Farrow to Finish
El
Gilts
El
Boars
10 Layer I
Dry Poultry
E]
Layers
El
Non -Layers
EJ
Pullets
❑
Turkeys
Tt=rke Poults
❑
Other
El
E] Other
. . I -I , W �.
Dischaaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; Ej Structure Ej Application Field El Other
a. "'as the conveyance man-made?
b. Did the discharge reach waters of the State? ffyes, notify DWQ)
El
Dairy Cow
[:1
Dairy Calf
El
Dairy Heitei
0
I]Cow
Ej
Non -Dairy
El
Beef Stocker
El
Beef Feeder
0
Reef Brood Cowl
7,
r4urn, b*e,r-' of Strbaures - -
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?
-,I
El Yes No El NA El NE
El Yes
E]No
NNA
El NE
❑ Yes
0 No
ro NA
❑ NE
NA
EJ NE
D Yes
0 No
[:1 Yes
D No
1T NA
EJ N f:
_[ Yes
0 No
NA —El
NE_
12128104 Continued

• Facility Number: - Date of Inspection ZZAAA
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 N❑ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure Structure 5 Structure 6
Identifier; /Xd / 1� 14L; 2, Y,60Z-J1LW.T
Spillway?:
Designed Freeboard (in):
CJ f R
Observed Freeboard (in): +j 3a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes #1 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, ctc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No El ElNE
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? M Yes ❑ No ❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? ❑ Yes {P 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 Up No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4 No ❑ NA ❑ NEs
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ­14 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ heavy Metals (Cu, In, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WindowEl Evidence of Wind Drill [I Application Outside of Area
12. Crop type(s) rGSCs. AYAVV,4Zi✓ I�h'X&AIV
13. Soil type(s)
14. Do the receiving; crops differ from those designated in the CAWMP? ❑ Yes V No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R1 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes ,V No ❑ NA ❑ NE
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 No ❑ NA ❑ NE
161C_1 . __ - .. . . . __ -
b
-raf��Tu ]Hunt'
MEw WNE'k � t_D0er4#Z-AD
L.C.
Reviewer/lnspector•Name- .
�- Reviewee/Insp&tvr Signature: - "--
i
1 ,

Facility Number: — Ote of Inspection
Res uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA Pq NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA 9 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
1� No
❑ NA
. ❑ N1?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�1 NA
❑ NI;
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
❑ NI:
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
No
❑ NA
❑ Ni?
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NI:
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�J No
❑ NA
❑ NEI
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
.Q 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
4�11 No
Cl NA
❑ NI;
General Permit? (ie/ discharge, freeboard problems, aver application)
32-
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
4KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4� No
❑ NA
❑ NE
r 77�7,�,�ar • xa � 1 j u xr , r: s� ..-,MP RA
. 'u n 1-71� �if��. "iFar"+113,4 � - 7
1 Mole tN6- Fd2 )WO k0AVS7 W/A56) avdlc2
I
s �if� 7".ZN�- Gt�: l lV �cJ 5rz s �IV�O 6t,Gfs �� /� c1►�k j�s �s
I Z (28/44

a
Facility Number: - 0 Date of Inspection is
Technical Assistance
Needed
Provided
34. Waste Plan Revision or Amendment
❑
35. Waste Plan Conditional Amendment
❑
❑
36. Review or Evaluate Waste Plan wlproducer
❑
37. Forms Need (list in comment section)
❑
❑
38. Missing Components Mist in comments)
❑
❑
39.2H.0240 re -certification
❑
❑
40. Five & Thirty day Plans of Action (PoA)
❑
❑
41. Irrigation record keeping assistance
❑
❑
42.Organize/computerization of records
❑
❑
43. Sludge Evaluation
❑
❑
44. Sludge or Closure Plan
❑
❑
45. Sludge removal/closure procedures
❑
❑
46. Waste Structure Evaluation
❑
❑
47. Structure Needs Improvement
❑
❑
48.Operation & Maintenance Improvements
❑
❑
49. Marker check/calibration
❑
50. Site evaluation
❑
❑
51. Irrigation Calibration
❑
❑
52. Irrigation system design/installation
❑
❑
53. Secure irrigation information (maps, etc.)
❑
❑
54. Operating improvements (pull signs, etc.)
❑
❑
55, Wettable Acre Determination
❑
56. Evaluate WAD certification/rechecks
.®
❑
57. Crop evaluation/recommendations
❑
❑
58, Drainage workievaluation
❑
❑
59. Land shaping, suhsoiling, aeration, etc.
[�
❑
60, Runoff control, stormwatcr diversion, etc.
❑
❑
61. Suffer improvements
❑
❑
62. Field measurements(GPS, surveying, etc.)
❑
63. Mortality BMPs
❑
64. Waste operator education
❑
_. ❑
65, Operation & maintenance education
❑
❑
66. Record keeping education
❑
❑
67. Crop/forage management education
❑
❑
68. Soil and/or waste sampling education
❑
❑
69. PLAT
❑
❑
70, Other
❑
❑
List ImFrovements Made by Operation:
041
4.
5.
3:
- 12128/04

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number : 760004 Facility Status: Active Permit: NCA276Q 4 ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Routine County: &ndolph Region:Winston-Salem
Date of Visit: 08/31/2006 Entry Time:09105 AM Exit Time: 11:00 AM _ Incident #:
Farm Name: Chriscoe Falco_ Owner Email:
Owner: Roy L Chriscoe _ Phone: 23$79-3585
Mailing Address: 4262 Fork Creek Mill Rd Seagrove NC 273418146
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35_35'30" Longitude: 79041'35"
Farm Location: US Hwy 220 south from G5O to NC Hwy 705 east. NC Hwy 705 east to Fork Creek Mill Road and turn left. Take first
right onto gravel drive after Pleasant Hill Road.
Question Areas:
Discharges & stream Impacts Waste Collection & Treatment Waste Application
Records and Documents Other Issues
Certified Operator: Roy L Chriscoe Operator Certification Number: 18300
Secondary OlCjsj:
On -Site Representatives): Name Title Phone
On -site representative Roy Chrisooe Phone: [phone]
24 hour contact name Roy Chriscoe Phone: [phone]
Primary Inspector: Melissa Rosebrock Phone:
Inspector Signature: Date:
Secondary lnspector(s):
Inspection Summary:
'4. Lagoons #1, #2, & #3 are at maximum currently. Are being allowed to flow into holding pond in preparation for tropical storm.
7. 91 and #2 have trees that need to be cut. Try to establish grass an #2 and #3.
21. Don't forget to record weather code for application days and initial IRR-2 that you are checking irrigation at least every 120
minutes.
24. Don't forget 2006 calibration.
25, Sludge surveys not required again until 2007.
26. Chad and Roy need 6 hours by end of year.
27. PLAT completed 7/25/06 and received in Raleigh. No fields were high or very high.
28. Pull 22 is listed as 2.2 acres in Wt1P. Operator is using 4.68 acres. Check wl tech specialist.
7/31/06 waste analysis=l.3 lbs. N11000 gal.
Page: 1

Permit: NCA276004 Owner • Facility: Roy L Chriscoe
Inspection Date: 08/31/2006 Inspection Typo: Compliance Inspection
Facility Number. 760004
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Swine
Swine - Feeder to Finish 8,025 7,934
Total Design Capacity: 8,025
Total SSLW: 1,083,375
Waste Structures
Type Identifier Closed Date Start Date Desinned Freeboard Observed Freeboard
agoon
"HOLDING POND"
90.00
agoon
#1 LOWER
12,00
agoon
#2 STAGED
36.00
agoon
#3 STAGE❑
18.00
Page: 2

0 0
Permit: NCA276004 Owner- Facility: Roy L Chriscoe Facility
Number:
760004
Inspection Date: 08/31/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No
NA
NE
1. Is any discharge observed from any part of the operation?
❑
■
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
MOO
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
■
❑
❑
c. Estimated volume reaching surface waters?
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 Waters of the State other than from a
❑
■
❑
❑
discharge?
Waste Collection, Storage & Treatment
Yes
No
NA
NE
4. Is storage capacity less than adequate?
❑
■
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le,/ large trees, severe
❑
■
❑
❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑
■
❑
❑
or closure plan?
7. Do any of the structures need maintenance or improvement?
■
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (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 maintenance or
❑
■
❑
❑
improvement?
Waste Application
Yes
No
NA
NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑
■
❑
❑
improvement?
11. Is there evidence of incorrect application?
❑
■
❑
❑
If yes, check the appropriate box below
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
Page: 3

Permit: NCA276004 Owner - Facility: Roy L Chriscoe
Facility Number: 760004
Inspection Date: 0851/2006 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Waste Application
Yes
No
NA
NE
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total P205?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crap Type 1
Matua (Hay)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑
■
Cl
❑
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
■
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑
0
❑
❑
17. Does the facility lack adequate acreage for land application?
❑
■
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
■
❑
❑
Records and Documents
Yes
No
NA
NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available? ❑ ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available? ❑ ❑ ❑
If yes, check the appropriate box below.
WU P? ❑
Page: 4

•
s
Permit: NCA276004 Owner - Facility: Roy L Chdscoe Facility Number : 7641]04
Inspection Date: 081 lMO6 Inspection Type: Compliance inspection Reason for Visit: Routine
Records and Documents Yes No NA NE
Checklists? ❑
Design? ❑
Maps? ❑
Other? ❑
21. Does record keeping need improvement? ■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
■
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker an irrigation equipment (NPDES only)?
❑
■
❑
❑
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 phosphorous loss assessment (PLAT) certification?
❑
■
❑
❑
Otherlssues
Yes
No
NA
NE
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 those ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air ❑ ■ ❑ ❑
Quality representative immediately.
Page: 5

Permit: NCA276004 Owner • FacIIIty: Ray t_ Chriscoe
Inspection Date: 08/31/2006 Inspection Type: Compliance Inspection
Other Issues
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
32. Did Rev iewe rllnspector fail to discuss rev iewlinspection with on -site representative?
33. noes facility require a follow-up visit by same agency?
Facility Number: 760004
Reason for Visit: Routine
Page: 6

- aoS r0.
Division of ►Pater Quality W
Facility Number 8Division of Soil and Water ('nnservatinn :oo11
po
Q Other Agency L
Type of Visit N Compliance Inspection ❑ Operation Review p Structure Evaluation Q Technical Assistance
Reason for VisitRoutine0 Complaint O Follow up Q Referral Q Emergency Q Other ❑ Denied Acces-s,� ��
Date of visit: l 3 j a l jU�j{ Arrival'I'ime: Departure Time: County: O Hegion: ]�
Farm Name:" COX0 �Q� Owner Lmail:
Owner Namc: &U
!� � M i Phone:
Mailing Addres� � A V� � Car �_ Lru- � 1 � 1 t l � i Q• 73 �
Physical Address: 3l
Facility Contact: " LE 5 CQ�e— Title: Phone No:
Onsite Representative: INL4 Nirt!5COe-,Integrator: PVr y-6
Certified Operator: L' v-1r` CQLO Operator Certification Number: � � -3oQ
Back-up Operator: 6 a I�Back-up Certification Number:
Location of Farm: Latitude: Longitude: ER
D ED I M—
(is Wtk>1 9,.1b Sa t rorvL /i5 he b Oro,
Turn I fob far e°.rPe. Mil[ P I ¢ri 'I �n �, a�'
Swine
Design Current Design Current
Capacity Population LN'et Poultry Capacity Population
❑ Layer
❑ Non -La er
❑
Wean to Finish
EL
Wean to feeder
Feeder to Finish
I 10oO
El
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharues & 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 or the State'? (If yes, notify DWQ)
Wes ' Current
Cattle Capacity Population
❑
Daia Cow
E]DairyCalf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)'?
Number of Structures: E9�
d. Does discharge bypass the waste management system? (If yes, notify ❑WQ)
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 Vwo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
El NE
El Yes
❑No
❑NA
❑NE
El YesfNo
❑ NA
❑ NI:
❑ Yes
[4No
❑ NA
❑ NF
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 1 Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �j �+' I L o "-r 2 - upA 3 Upp��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?j 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes �6.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 0No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public stealth or environmental threat, notify ❑WQ
7. Do any of the structures need maintenance or improvement'? Yes ❑ No ❑ NA ❑ NE
R. 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 T� o ❑ NA ❑ NE
maintenance or improvement'!
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes �o ❑ NA ❑ NE
mai ntenan cc/i mprovcment?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, [Dyes ;k o ❑ 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 ❑ A lication Outside of Arrt
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the. CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
o
❑ NA
❑ NI?
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
ElNA
❑ NE
I S. Is there a lack of'properly operating waste application equipment''
❑ Yes
�kNo
❑ 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):
4.
Reviewer/Inspector Name
Reviewer/Inspector Sign at e
1 Phone:
Date: Q
Page 2 of 3 tPj tb 4, 4
;- +, ,3 ` 12128104 - Cunrinered

f
Facility Number: -- 0 date of Inspection (p
Re aired [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 I`No ❑ NA ❑ NE
the appropriate box.
❑ WUE' ❑ Checklists El Design El Maps ❑ ether
21. Doe record keeping need iimm rovement. Yes ❑,,_Na- ❑ NA ❑ NE
W aste Appli lion ;�Crop
ly Freeboard Waste Analysis �Analysis Waste'I'ransfers FAnnual rtification
[� Rainfall L7 Stocking Yield 120 Mimiie Inspections (Monthly and I " Rain Inspections Weather { oc3
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NEE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Ycs IANo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? a ❑ Yes No ❑ NA ❑ NE"s
25. Did the facility fail to conduct a sludge survey as required by the pennit? ❑ Yes 1XNo ❑ NA ❑ Nli
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility flail to secure a phosphorus loss assessment (PLAT) certification'?e%,0_C1�-, ❑ Yes ❑ No ❑ NA ❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP `? ❑ Yes No ❑ NA ❑ NE,
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE,
and report the mortality rates that were higher than normal?
30. At the time of the inspection (lid the facility pose an odor or air quality concern? ❑ Yes ANo ❑ NA ❑ NE
Ifyes, contact a regional Air Quality representative immcdiately
31. Did the facility fail to notify the regional office ofernergency situations as required by ❑ Yes �0 No ❑ NA ❑ NE
General Permit? (ic/discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'? ❑ Yes KN❑ ❑ NA ❑ Nl?
33. Does facility require a follow-up visit by same agency? ❑ Yes "%No ❑ NA ❑ NE
I C
Additional Comments and/or Drawings:
c� �-L �S lr t'C Q - aco (a
a� • � �l�s!- �� � �a�� Yl �-� S + X irla v [`S � � �lc� a� �'.
t i�7 `t%le D �•� u S CO wz
a�`� T'V � � � r�• 1 � � l � �'� Q.� � � try i �l i.+� i.3 �� t� C_U r�S �'1 a V � �-{ • �v
6-w- ,
a� 1`st ev-�{ �z� lmthuteS t4 �hecl��
0G 1600
Page 3 of 3 � n LL, f V) �C-t 1 l S 12/28/04

�{ z 0 Division ofWatc`r Quality'-
IF�ae.�3`:i. ."• �:. - .!/ i ,a: •� f`:r•'�a5:
HaClIlty`iti`U[I1kiC! �L 0,Di�i'%im of Siiiliand Water Cnnscr�atiun. }�"s�&...
r•'Ar�y o, � x � N
Type of Visit ❑ Compliance Inspection �1 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit q Routine ❑ Complaint ❑ Follow up 4 Referral ❑ Emergency ❑ Other ❑ Denied Access
[late of Visit: I Arrival Tinre: Departure f inke: = Counly: '-P6j-9W p� Region:
Farm,Name: Owner Email: p�
Owner Name: jr-N CQC� Phone:
Mailing Address: 2i 2_ w L.t—rJ�Jlka�— 4 ' 2Lc
Physical Address:
Facility Contact: [�riSCf'a 1'itic: Vc^��t-
Onsite Representative:
Certified Operator:_
Back-up Operator:
['hone No:
Integrator•-i �LUIVID
Operator Certification Number: -! 1%0
Back-up Certification Numher:
Location of i'arm: Latitude: ©�� © ®f Longitude: ®o ©` ©"
}.V � . 2W 'Pxo A4) fro . -Tt, H� e4 -/Q5 t • -To �fw c'. }� '. U ?A • �' -T i L
ut?I J 1�
Swine
Design Current llesign Current
Capacity Population Wet Poultry Capacity Population
❑ i_aver
❑ Non -Laves
❑ wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ other
Dry Poultry
❑
La 'ers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Puults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed From any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'!
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Ile i66
❑
Dry Cow
❑
Non-Dairy
❑
Beet'Slocket
❑
Beef Feeder
❑
Bect'Brood Cowl
I
Number of Structures: RI
h. 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 D%VQ]
?. 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 Water, of the State
other than trom a discharge'?
❑ Yes EYNo ❑ NA ❑ NE;
❑ Yes ❑ No q NA ❑ NE
❑ Yes ❑ No �J NA ❑ NE:
❑ Yes ❑ No C�NA ❑ NE:
❑ Yes No ❑ NA ❑ NE:
❑ Yes No ❑ NA ❑ NE;
12128104 Continued

Facility ,Numlier: of Enspeetion c'-tiF1
Required_ Record% & Documents
19. laid the facility fail to have Certificate of Coverage & Perin iI readily available"
20. [does the facility fail to have all components ot'the CAWM1' readily available? Ifyes, check
the appropirate box. ❑ '4 UP ❑ Checklists ❑ Design ❑ IV7:aps ❑Other
❑ Yes
r1l No
El NA
❑ NF
❑ Yes
)eNo
❑ NA
❑ NI:
21. Does record keeping need improvement? lt'yes, check the appropriate bray Belo..'. ❑ Yes 9No ❑ NA ❑ N1:
[] Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Raintali ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V }fain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. ]('selected, did the facility tail 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 stin•cy 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 lass assessment (PLAT) certification?
Other ]%site%
2K Were any additional problems noted which cause non-compliance aF(lie permit or CAWMP?
29. [aid the facility Fail to properly dispose ol'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 faciIity pose an odor or air quality concern?
if yes, contact a regional Air Quality represcntutive immediately
31. Did the facility fait to notify the regional off ice of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Keviewerlfnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or drawings:
(Wby(,� UA�l node l —&r3 Ed ea-►� �� �f
J&S un
❑ Yes
91 No
❑ NA
❑ N E
❑ Yes
❑ No
N NA
❑ NI:
❑ Yes
[X No
❑ NA
❑ Ni:
❑ Yes
M No
❑ NA
❑ N I i
❑ Yes
Q No
❑ NA
❑ NE
❑Yes ®No ❑NA ❑Nl:
❑ Yes fWNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ N1:
❑ Yes [YNo ❑ NA ❑ NE
❑ Yes & NO ❑ NA ❑ NE
❑ Yes [5No ❑ NA ❑ NI"
[]Yes fgNo ❑ NA ❑ NE
12128104

r Facility Number:
Date of Inspecliun
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OdNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard'' ❑ Yes ❑ No "P,NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ALzt,JS(,-- a
Spillway?:
Designed Freeboard {in):
Obsemed Freeboard (in); Lg'� L, t l VI 0=11
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes Wo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Ycs �'o ❑ NA ❑ NEE
through a waste management or closure plan''
If'any (if questions 4-6 were anshered ►'es, and the situation poses an immediate public health or environmental threat, notify ❑WQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
kNo
❑ NA ❑ NE
S. ❑o any of the stuctures lack adequate markers as required by the permit'?
[] Yes
FNo
❑ 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
O No
❑ NA FINE
maintenance or improvement?
Waste Application
10. Are there any required huffers, 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
Q No
❑ NA ❑ NE;
❑ Excessive Ponding ❑ I Iydraulic Overload ❑ Frozen Ground ❑ I Ieavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > I W/o or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of'Acceptahle Creep Window ❑ Evidence of Wind Dritl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops difTer tram those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/ear land application site need improvement'?
❑ Yes
14 No
ElNA
ElNE
I6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination';[:]
Yes
�J o
IP
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
El Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
*0
❑ NA
❑ NE
-Comments (refer to question #): Fxplain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:�j�j-3��
Reviewer/Inspector Signature: Datc:5V
V 12128104 Continued

Facility Number; `9. -hq I )ate of Inspection
Technical AsSlstfl ce
Needed
Provided
34. Waste Plan Revision or Amendment
❑
❑
35. Waste Plan Conditional Amendment
❑
❑
36. Review or Evaluate Waste Plan w/producer
❑
❑
37. Forms Need (list in comment section)
❑
❑
38. Missing Components (list in comments)
❑
❑
39. 2H.0200 re -certification
❑
❑
40. Five & Thirty day Plans of Action (PoA)
❑
❑
41. Irrigation record keeping assistance
❑
❑
42. Organize/computerization of records
❑
❑
43, Sludge Evaluation
❑
❑
44. Sludge or Closure Plan
❑
❑
45. Sludge removal/closure procedures
❑
❑
46. Waste Structure Evaluation
❑
❑
47. Structure Needs Improvement
❑
❑
48.Operation & Maintenance Improvements
❑
❑
49, Marker check/calibration
❑
❑
50. Site evaluation
❑
❑
51. Irrigation Calibration
❑
❑
52. Irrigation system design/installation
❑
❑
53. Secure irrigation information (maps, etc.)
❑
❑
54.Operating improvements (pull signs, etc.)
❑
❑
55. Wettable Acre Determination
❑
❑
56. Evaluate WAD certifscationlrcchecks
❑
❑
57. Crop cvaluation/recommendations
❑
❑
58. Drainage work/evaluation
❑
❑
59. Land shaping, subsoiling, aeration, etc.
❑
❑
60. Runoff control, stormwatcr diversion, etc.
❑
❑
61. Buffer improvements
❑
❑
62. Field measurements(GPS, surveying, etc.)
❑
❑
63. Mortality BMPs
❑
❑
64. Waste operator education
❑
❑
65.Operation & maintenance education
❑
❑
66. Record keeping education
❑
❑
67. Croplforage management education
❑
❑
68. Soil and/or waste sampling education
❑
❑
69.PLAT
❑
❑
70.Other
❑
❑
list Improvements Made by -Operation:
I .
4.
2. 5.
3. 6.
12128104

t 0 0
Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 760004 Facility Status: Active Permit: NCA276004 ❑ Denied Access
Inspection Type: Compliangg In§pegtion Inactive or Closed Date:
Reason for Visit: Routine County: Randolph Reglon: Winston-Salem
Date of Visit: 07/06/2005 Entry Time: 12030 PM Exit Time: 02:30 PM Incident #:
Farm Name: Chriscoe FarmsOwner Email:
Owner: 13ov L Chriscoe
Mailing Address: J62 Fork Creek Mill Rd
Physical Address:
Phone: [phone]„5
Facility Status: ❑ Compliant ❑ Not Compliant Integrator: Purvis Farms Inc
Location of Farm: Latitude: 35°35'30" Longitude: 79°41'35"
Farm Location: US Hwy 220 south from GSO to NC Hwy 705 east. NC Hwy 705 east to Fork Creek Mill Road and turn left. Take first
right onto gravel drive after Pleasant Hill Road.
Question Areas:
0 Discharges & Stream Impacts Waste Collection & Treatment 0 Waste Application
0 Records and Documents 0 Other Issues
Certified Operator: Roy L Chriscoe
Secondary OIC(s):
Operator Certification Number: 18300
On -Site Representative(s): Name Title Phone
On -site representative Roy Chriscoe Phone: [phone]
24 hour contact name Roy Chriscoe Phone: [phone]
Primary Inspector: li sa M Rosebrock
Inspector Signaturl:
Secondary Inspector(s):
Phone: [phone]
Ext.383
Date: ■
Phone:
Phone:
Inspection Summary:
7. Need to seed bare spots on dam of #2 this fall. Operator wants to dig into the embankment between #2 and #3 to repair valve.
Must work with NRCS.
24, Operator says he calibrated equipment and described procedure. No records to document at this time, however. Need to document
by the end of 2005.
25. Per DWO, sludge survey not reuired again until 12/31/2007.
27. PLAT was due 1012/05. See tech specialist for assistance.
28. May need to change the CAWMP from Bermuda to fescue for pull #12.
Waste analyses:
1121105=1.5 lbs. N
4125105=1.3 lbs. N
Page: 1

0 0
Permit: NCA276004 Owner - Facility: Roy L Chriscoe
Inspection Date: 07/06/2005 Inspection Type: Compliance Inspection
r
Facility Number: 760004
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Swine
Swine - Feeder t0 Finish 8,025 7,287
Total Design Capacity: 8,025
Total SSLW: 1,083,375
Tyne Identifier Closed Date Start Date Desloned Freeboard Observed Freeboard
Lagoon
"HOLDING POND"
60.00
Lagoon
#1 LOWER 77
16.00
Lagoon
#2 STAGED
24.00
Lagoon
93 STAGED
20.00
Page: 2

•
•
Permit: NCA270004 Owner - Facility: Roy t_ Chrisooe Facility Number: 760004
Inspection Date: 07/06/2005 Inspectlon Type: Compliance Inspection Reason for Visit: Routine
Disrharges & Stream Impacts Yes No NA NF
1, Is any discharge observed from any part of the operation? ❑ M ❑ ❑
Discharge originated at:
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ N ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ 0 ❑ ❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
Cl
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0
❑
❑
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a discharge?
❑
Yes
0
No
❑
NA
❑
HE
Waste Collection_ 5toraaeK Treatment
4, is storage capacity less than adequate?
❑
0
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the Integrity of any of the structures observed (I.e.1 large trees, severe erosion,
❑
0
❑
❑
seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management or
❑
❑
0
closure plan?
7. Do any of the structures need maintenance or improvement?
0
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (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 maintenance or
❑
❑
❑
improvement?
Yes
No
NA
NE
Waste Ao_niicatiga
10. Ara there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement?
❑
■
❑
❑
11- Is there evidences of incorrect application?
Cl
0
❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
Cl
Heavy metals (Cu, Zn, etc)?
Cl
PAN?
❑
Is PAN n 10%10 Ibs.?
❑
Total P2057
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1 Fescue (Hay)
Crop Type 2 Millet
Crop Type 3
Crop Type 4
Crop Type 5
Page: 3

Permit: NCA276004 Owner - Facility: Roy L Chriscoo
Inspection Date: 07/06/2005 Inspection Type: Compliance Inspection
Facility Number : 750004
Reason for Visit: Routine
Waste Application
Crop Type 6
Yes
No
NA
NF
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑
■
❑
❑
15. Does the receiving crop andlorIand application site need'improvement?
❑
■
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑
■
❑
❑
17. Does the facility lack adequate acreage for land application?
❑
■
❑
❑
16. Is there a lack of properly operating waste application equipment?
❑
Yes
■
No
❑
NA
❑
NE
Records and Documents
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does retard keeping need improvement?
❑
■
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute Inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after a 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDFS only)?
❑
■
❑
❑
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?
❑
■
❑
Cl
27. Did the facility faii to secure a phosphorous loss assessment (PLAT) certification?
❑
■
©
❑
Pa ge: 4

•
s
Permit: NCA276004 Owner - Facility: Roy L Chdscoe Facility Number : 760004
Inspection pate: 07/06/2005 Inspection Typo: Compliance inspection Reason for Visit: Routine
Other issues
28. Were any additional problems noted which cause non-compliance of the Permit or CAW MP?
YVS
❑
No NA
0 ❑
JtE
❑
29. Did the facility fail to properly dispose of dead animals within 24 hours andfor document and report those mortality
❑
rates that exceed normal rates?
30. At the time of the Inspection did the facility pose an air quality concern? if yes, contact a regional Air Quality
❑
M ❑
❑
Topresontative immediately.
31. Did the facility fail to notify regional DWO of emergency situations as required by Permit?
❑
M ❑
❑
32. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑
❑
❑
33. Does facility require a follow-up visit by same agency?
❑
❑
❑
Page: 5

I
I�')
4'
`Division of.�Vatct�,fruality ��•; - •� 3h:
aCility NurrlbLr I)i►•ision of.Snil'anii M ter Co scrvatioti; a r f,
o g : y �k �, . ,. -7t.o1. � ,..
5! �
Other A enc t.� 1)r
'.. [4
Type of Visit Compliance Inspection Q operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit Routine d Complaint O Follow up Q Referral Q Emergency Q other ❑ Denied Access
Date of Visit. Arrival Time: ® 1)cparture'I'imc: `lL,1 � "nty: L44nd o- Region:
Farm Name:rcv�—tc � ` "-' Owner Email:
[l►ti'ner Nrime: `—r�� L�{,���` �,' �Q. phone:�•��7�
Tailing Address: � � (D R Fpc � Lret � �_� l l� [� � � r'0 V� 1 AX
Physical ,address: C r �� Cr e-,t—_l �.�.�1_ . �t�J lyd
Facility Contact: { 6 CA) i Coe Phone No:
Omite Representative: �o� S��_�► 5� ❑ Q_ Integrator: r `1-o P rV �S FC�� T C .
Certified Operator: — �' 7 � S C-dOperator Certification Number: _] g 3 0 d
Back-up Operator: �4[ I�`L�� r� ��Q_P _ Rack -up Certification Number:
Location of farm: Latitude: 5�!r � Cam., Longitude: La
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I ❑ La -er
El Wean to KFeedEl Non -Laver
Feeder to Finier
El Farrow to Wean Dry Poultry
❑ FMIMN to Feeder
❑ Farrow to Finish
[--]Gilt,,
❑ Boars
Other
❑ Other
❑ Lavers
❑ Nan-L,.s err
❑ Pullets
❑ Turkeys__
❑ TUrkev Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dalr-v Flerfel
❑
Dry Corr'
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Bumper of Structures: M
Discharges R Stream Imparts
1. Is any discharge observed From any part of•the operation?
❑ Yes
qNo
❑ NA
❑ NE
Discharge originated at: ❑ Stnicture ❑ Application Field ❑ Other
a. Was the conveyance nian-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of (lie State'? (If yes, notify DWQ)
❑ Yes
❑ Na
❑ NA
❑ NE
c. What is IIIe estimated volumc that reached waters of'the State (gallons)'?
d. Does discharge bypass the waste management system? (Il'yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of'a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
?. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge`?
`
12128104
Co► finned

Facility ,Number: — DC Date of Inspection
' Waste Collection & Treatment ANo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ElYes ❑NA ElNEBa. If yes, is waste level into the structural freeboard? ElYes No ❑ NA ❑ NE
Structure i tructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier41 :
407 21 1 L, V;, V.,
Spillway?. LV
Designed Freeboard (in);
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? 3 ❑ Yes No 0 NA
large
❑ NI:
(ie/ trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElNo ElNA
❑ NE's
through a waste management or closure plan? f
If any of questions 4-6 were ans►yered yes, and the situation poses an immediate public health or enrtronmen tal threat, notify D%VQ
7. Do any of the structures need maintenance or improvement? 4Yes ❑ No ❑ NA
❑ NI;
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 0 Yes �No ❑ NA
ElNF
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? ]ryes, check the appropriate box below. ❑ Yes No ❑ NA
❑ NE
❑ /Excessive Ponding ❑ Ilydraulic Overload ❑ Froxen 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 Crap Window ❑ I'svidence of'Wind Drift ❑ Application Outside of Area
12. Croptype(s) r'e,S[.Ue,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
El NA
ON E
15. Does the receiving crop and/or land application site need improvement?
El Yes
tNo
❑ NA
❑ NE
I& Did the facility flail to secure and/or operate per the irrigation design or wettable acre determination
❑ Yes
o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
pi7 No
❑ NA
❑ NE
18. Is there a sack of properly operating waste application equipment?
El Yes
I� No
❑ NA
❑ Nl;
Comments (refer to question'#): Explain any YF S answers and/or any recommendations or any other comments..'
Use drawings of facility to better explain situations. (use additional pages as necessary):
u_"
VV
Reviewer/Inspector Name I Phone: �• V
ReviewerAnspector Signature: Date:
- v ' - v 12128104 Continued

i
Facility 1\umber: D-of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate cif Coverage & Permit readily available'?
20• Does the facility fail to have all components of the CA%VMP readily available'? If ycs, check
the appropirate box. ,
El Vt Uf El Checklists ❑ Design El Maps El Other
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21. Do • record keeping need imp v iirr}t'illf vcs, chec • he appropriate box b low. ❑ Yes 9No NA ❑ NE
sic A lie• lion '+Peck I�reeboTV120
aste Analysis soil Analysis Waste Transfers �Zeathcr
l Certification
pp _
Vr
RainFall pp Stoc:kinb Crop YieldMinute: Inspections �Munthly and 1" Rain Inspections Code
77. Did the facility fail to install and maintain a rain gauge'? ❑ Yes 4 No ❑ NA ❑ NE
23.
€t'selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes
❑ No
�(NA
❑ Nl:
24.
Did the facility tail to calibrate Nvaste appiication equipment as required by the permit? 12�j 12151 JC(S Yes
t%No
❑ NA
❑ NE
25.
Did the facility Elul to conduct a sledslud r�ts required by the permit? NJe,6 1 �a f jro� ❑ Yes
)(No
❑ NA
❑ NE
26.
Did the facility tail to have an actively certified operator in charge'? ❑ Yes
XN o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment ( PLAT) certification'? A P ❑ Yes
�No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V No ElNA ElNE
29.
Did the facility Fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Nei
❑ NA
ElN1;
and report the mortality rates that were higher than normal'?
�T�y
30.
At the time of (lie inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
Yves, contact a regional AirQua Iity representative irnniedimely
31.
Did the facility tail to notify the regional oflice of emergency situations as required by
❑ Yes
o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
]]��
32,
[did Reviewcrllnspector tail to discus, .; review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
hoes facility require a 1i611ow-up visit by same agency?
❑Yes
dNq
❑ NA
❑ Nf=
Additional Comments andlor Drawings: ' (11OU
Vet i v t c�ep� r e jweer,,
�D Its- )kl,-5. r,�J/l000
9 J A 5-1 d-rT -::: 1.3/N 11000
1 �
12,128104

chnical Assistance Site Visit Report
5AWn of Soil and Water Conservatiorl
Natural Resources Conservation Service
Soil and Water Conservation District
Other...
Facility Number 7$ - ® pate: 12115J04 Time: 1 1200 j Time on Farm: 100 WSRO
Farm Name Chriscoe Farms
Mailing Address 4262 Fork Creek Mill Road
County Randolph Phone
336-879-3585
Seagrove NC 27341
onsite
Representative Roy Chriscoe - - integrator N G Purvis Farms, Inc.
Type Of Visit
Operation Review
Compliance Inspection (pilot only)
Technical Assistance.
Confirmation for Removal
❑ No Animals -Date Last Operated:
❑ Operating below threshold
® Swine ❑ Poultry ❑ Cattle ❑ Horse
Purpose Of Visit
QQ Routine
Q Response to DWQ/DENR referral
Q Response to DSWC/SWCD referral
Q Response to complaint/local referral
0 Requested by producer/integrator
D Follow-up
Q Emergency
O Other...
Design Current Design Current
Capacity Population Ca aci Population
❑ Layer
❑
❑ Wean to
Feeder
® Feeder to Finish
8025
7898
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL_ QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees,
❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding
❑ yes ®no
requiring DWQ notification? V
5• Is there evidence of improper dead animal disposal that poses a threat to the environment
❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure?
❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4
Structure 5
Identifier 1 2 3 1 4 JF
Level (Inches) +6 NA I I NA IF+oft 11
CROP TYPES IFescue-hay ISmall g rain overseed mixed cool gras irescuegrass - hay
SPRAYFIELD
SOIL TYPES GeB2 Cab
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

a
a
Facility Number 76 - 4 Date:
12/15/04
PARAMETER
Q No assistance provided/requested
❑ 8. Waste spill leaving site
❑ 9. Waste spill contained on site
TECHNICAL ASSISTANCE Needed
Provided
10. Level in structural freeboard
25. Waste Plan Revision or Amendment
El
El
❑ 11. Level in storm storage
26. Waste Plan Conditional Amendment
❑
❑
27. Review or Evaluate Waste Plan wlproducer
❑
❑
❑ 12. Waste structure integrity compromised
28. Forms Need in
❑
El
El 13. Waste structure needs maintenance
(list comment section)
29. Missing Components (list in comments)
❑
❑
❑ 14. Over application >= 10% & 10 lbs.
Over application < 10% or < 10 lbs.
30. 2H.0200 re -certification
El
El
❑ 16. Hydraulic overloading
El
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 17. Deficient irrigation records
❑ 18. Late/missing waste analysis
33. Organ izelcom puterization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
❑ 21. Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removal/closure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
❑ 23. Irrigation maintenance deficiency
❑ 24. Deficient sprayfield conditions
38. Structure Needs Improvement
❑
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Regulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to ❑WQ Date:
42. Irrigation Calibration
ElElElReferred
to NCDA Date'
43. Irrigation designlinstallation
❑
❑
❑ Other...
system
pate:
44. secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45. Operating improvements (pull signs, etc.)
®
❑
MADE BY OPERATION
❑
❑
46. Wettable Acre Determination
1.
47. Evaluate WAD certificationlrechecks
❑
❑
48. Crop evaluationtrecommendations
❑
❑
z.
49. Drainage worklevaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
3
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
El
❑
4'
54. Mortality BMPs5.
❑
❑
55. Waste operator education (NPDES)
56. Operation & maintenance education
❑
❑
57. Record keeping education
6.
58. Croplforage management education
❑
❑
59. Soil andlor waste sampling education
03/ 10/03

/ 1
•
IFacility Number 76 - ® Date: 12/15/04
1COMMENTS:
'COC - current & onsite +'
analysis - 81610 N = 1.2 Ibs11000 gal -----> 616104 to 1016104
416104 N = 2.4 Ibs11000 gal -----> 216104 to 616J04
analysis - 819104 - no problems
in records - depths for #1 & #4 - complete
ill - recorded weekly - need to keep daily & inspect after 1" or more & initial
c records - can use 251 Ibs PAN on mixed grassed, has been using 186 Ibs PAN (like fescue)
- never exceeded PAN.
aste sample is good for 60 days before AND after sample date
-- need to take sample by 12/25/04 for Oct applic
rolls hay (10001b) on 78 acres this year
---> need to start recording yid records on harvest for all spray flds
records - need to start keeping at least monthly
ed to record weather code & initials on IRR1 & 2
---> left copy of new forms
to document irrig cal & put in records book
survey - NRCS helped - extended next sampling for a year
has fixed reels
not fixed valve btn #2 & 3 - waiting for NRCS before digging
has not checked lagoon marker in #1
- look good, good veg cover
s - look good, subsoiled & reseeded spray flds
to check air relief valves on irrig system & address as needed
TECHNICAL SPECIALIST 113etsy K. Gerwig
SIGNATURE
Date Entered: 12/17/04 1 Entered By: 113etsy K. Gerwi
3 03/10/03

A y ision of Water {duality
ision of Soil and Water Conservation
r Q Other Agency
Type of Visit Q Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit @ Routine 0 Complaint Q Follow up 0 Emergency Notification Q Other ❑ Denied Access
Uate of Visit: 8l2�12063 Tirne: t3l}0
Facility Number 76 04
Q ,Nrft O erational Q i3elow Threshold
❑ Permitted ® Certified ❑ Conditionally Certified ❑ Registered Date last Operated or Abov a '1'hreshuld:
Farm Name: Cttxxsct]e.k:a>rrt> ...................... .... County: RAII&IP11......................................... NYSE io........
Owner Name: &a' ........................................... '01:05c..................................................... Phone ,No: ���-#.7.`�.:�.�#�.......... ...... ...... .......
..............................
Mailing Address: 262.k:.V.CIf.�.rv&.1►.'i.ili.liQ.Aj...................................
Facility Contact: .................. .. Title:.......
Onsite Representative: buy;,,17t)cl.hr.IBC.G...,lcrt]..I��+v...................
5. tut.:t:tl.Yx.tNC......................................................... U.341...
Phone No: 33,6n&,7,9,.14 _49..Fjjr.jU ..........
Certified Olxra(or:RQ)'..L.................................... Chrb.gtic.................... ...................... . Operator Certifrc:itiori Nunilter:J.N311U.............................
Location of Harm:
Farm Location: US Hwy 220 south from GSO to NC Hwy 705 east. NC Hwy 705 cast to Fork Creek Mill Road and turn left.
akc first right onto gravel drive after Pleasant Hill Road.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude F 41F-3-576.
Design Cu rrent
Swine C anacity Ponulation
❑ Wean to Feeder
® Feeder to Finish
8025
7864
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
-._...... .
Design Current Design Current
Poultry Ca aeit❑ Population Cattle Ca aci(y Population
❑ Layer I ❑ Dairy
❑ Non -Laver I IQ Non -Dairy
❑ Qther
Total Design Capacity 8,025
Total SSLW 1,083,375
Number of Lagoons 4 S rav Field Area
0
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it retch Water of the State? (!ryes, notify DWQ)
c. if discharge is observed. what is the estimated no". in oat/min?
di Does discharge bypass a lagoon system? (lf'yes, notify DWQ)
❑ Yes ❑ No
❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? [-]Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of'the State other than from a discharge? ❑ Yes ® No
Waste Collection .5c Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ #.1..L Qwer........ .......A2 31aged................U-Uppzr............1lsalding.pond.........................................................................
Freeboard (inches): 17 36 3 60
12I12103 Continued

Facility ;Number: 76-04 I* Date of 1 nspectio11 8124120U 3 0
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(if any of questions 4-6 was answered yes, and (lie situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement^ ® Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/ititprovement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ® No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. is there evidence of over application? If yes, check the appropriate box below, ❑ Yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Fescue (I lay)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWiv1P)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This faciIity is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? [-]Yes ® No
16. Is there a lack of adequate waste application equipment^ ❑ Yes ® No
Odor Issues
17. Does the discharge pipe from the confinemcnt 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 ® No
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 ® No
Air Quality representative immediately.
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): �� field Copy ®Final hates
Reviewer/Inspector Name Mel'ssa Rosebrock
Reviewer/Inspector Signature.R J, 4A14 LAVY IL At,Date:
1211211i3 Continued

F;tcility ber: 76-4}4 1)f of Inspection 8/24/200
0
Required
Records & Documents
21,
Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
❑ Yes
N No
22.
Does the facility Fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
N No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
N No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
j 24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
' 25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(icl discharge, freeboard problems, over application)
❑ Yes
N No
27.
Did Reviewer/Inspector tail to discuss review/inspection with on -site representative?
❑ Yes
N No
28.
Does facility require a rollo%%r_Up visit by same agency?
❑ Yes
N No
+ 29,
Were any additional problems noted which cause noncompliance of the Certified A WMP?
❑ Yes
N No
Ij N11D S Perntiltcd Facilities
30,
Is the facility covered under a NPD1:S Permit? (If no, skip questions 31-35)
N Yes
❑ No
31,
]f selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N No
33.
Did the facility fail to conduct an annual sludge survey?
N Yes
❑ No
34.
Did the facility flail to calibrate waste application equipment?
N Yes
❑ No
35.
Does record keeping for NPD) S required forms need improvement? If yes, check the appropriate box below.
❑ Yes
N No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After l" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Additional Comments and/or Drawings:
7. Valve between #2 and #3 does not work. Waste must be pumped from 42 to #3. Need to repair valve. AL
9, Must record waste level in #2 until valve is repaired, 7 V�
9. Marker for #I may be set 12" too high? have SWCDINRCS check. ����.
15. Hare areas in matua fields arc coming back. AL r �4 5 j r
16. Need ne%v gauges on reels. need maintenance on gun of one reel. pj
23. Must record for #I and #4 always and #2 until valve is repaired. [� 1�
23. 2004 soils Lre ok.
31. Operator stays with irrigation equipment.
816104 waste analysis=1.2 lbs. NI1000 gal. 1
'WI
12112103

Water�QuaIity ' '�r.:�.' :.; � ',� 3�� x- ' ! �'r' • • .
5ni1 and}Water.Goriseiwatioa.p= w ~g-rf�;;�3.,
�!""�•. Yi+. �iZ Yps �:zre - ,5�-.. �y.(y_ .z•�•y, _.�,�:�-.__�— _.� �.. ,.,�c '•�.,"2'd ie'- - -T -,�.-� "Yr". +-x+-� al" _�: r
_ •':,_�� - c.':'�Y-•r--� ��'....� �'�r��__ ._�-,....• r��;,, �'F:: r.]' : � ::;"�.aer+_,:.'�i: �..i«-- -- .: � ^_�d.,_.K F, .,.,� ' -?r f_."'.f �.�•.�'.FL':'�",4-.. ti
Type of Visit%�
Compliance Inspe 1 n O Operation Review O Lagoon Evaluation
Reason for Visit �i Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: jam Time:
Q Not Operational d Below Threshold
Permitted 13 Certified C3 //Conditionally Certified 13 Registered Date Last OperaMor Abo►•e Threshold:
Farm Name: ... �.�,1 r ? .... Q.r..........................•-•----•-•- County: .. ).............. . »_.......
r� a r7 •
Owner Name: _ ? r� .. W.._ ._ ._. .. 'Phone No: _ -.��?. ..! '.. ..
Mailing Address: ..... 2 .l.._Q K_. 1D! ��...._!..:..ti. _ ._ . �q. r.. Y.. r ..7 31
{�. Y ___. �..._. .,.._p ......_. --
Facilih, Contact: L�—�}4 EZ' . � Tine Phone No: ..S �_9 .dY q . F
Onsite Representative:..�4f,
�1... Integrator: �`!... V.r
Certified Qperator:......I�?.....!-' ...r��� �.. .. Operator Certification Number:.❑... 0
Location of Farm:
)S � d- a-o So -From 666 I� hey io5;2�s�-
o r L- t- r r
Swine ❑ Poultry [ICattle 0 Horse Latitude r " Longitude ■
El Wean to Feeder
Feeder to Finish
EJ'Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
n Boars
Desi Cilri ent
Ca act ` Po olation'"~'I?oultry.- 'Ca -act =Po ulitirrn Cattle Ca act Po ulaiion=
Kr ❑ Layer ❑ Dairy
r❑Non -Layer ❑ Non -Dairy
,,IE3 Other
_
Y TotapesiHJ gn _Capacity,,; �.
Tom77
....
Discharges & Stream lmeacts
I. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge Priginated at: ❑ Lagoon ❑ Spray Field ❑ Other
a: If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b.' If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Stare other than from a discharge? ❑ Yes MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway ❑ Yes No
ff Structure ] tructure 2 Structure S c 4 S ture 5 Structure
Idcn[ifer: ...i i�.�•r __._.. .......... -- -
...t ..__............ - -- _ �� .._...._.. 31. _....... 1.. .. G .._...
Freeboard (inches):
12112103' �.� YG V� Continued

Facility Number: — Date of Inspection a
' 5. Are there any immediate threats to the i*ty of any of the structures observed? (ie/ treovere erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yesNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) `
7. Do any of the structures need maintenance/improvement? A Yes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes XN0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes KNO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes IgNo
11. Is there evidence of over application? If yes, check the appropriate box below, ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload []Frozen Ground ❑ Copper and/or Zinc
12: Crop tyre
13. Do the receiving ops differ with those Jesignated in the Certified Animal Waste Management Plan (CAWN2)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? El Yes X.
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes �NO
15. Does the receiving crop need improvement? ❑ Yes Po
16. Is there a lack of adequate waste application equipment? ❑ Yes xjto
Odor 1_rsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes tN
o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yeso
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 ANO
Air Quality representative immediately.
• --• f•3: �•,.r....��r� - ,�:- s = `t .- .._ - .. ..-.,.y....�r- r=.m'.-•-_ •;,-+rr-r�r-x.�tr. �.rr. �r-. i.r�si�- _
Corr meats (iYfei. to question #) ' Explain any YES answcfs�a xdlor. any. reeommeadatzons or. y�otner comments:
Use drawings of facility to better. explata situations. (use additional pages as accessary): Feld Copy ❑ Fnal Noes
--
.... +
n'0_Qj '_'o r_1_111V 3'j
a14-
;i�*,�43. nzg_4 is
�"'L
Reviewer/Impector Name ; ;,�-�[1[`_s 77
Reviewer/Inspector Signatur Date:
1212210 ' e S f t ~ ►t-C' L
ck �� M t"f �U �ietued

>1•ac0ity Number: -1-041 Date of Inspection
Rem[ uircd Records & Documents 9 0
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W"UP, checklists, design, maps, etc.) ❑ Yes o
23. ❑ record keeping need - 'rovement? If , check the apToil
ate box below. ❑ Yes W 'o
Waste Application Freeboard � to Analysis Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑
26. FaiI to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes ewo
27. Did Reviewer/Inspector fail to discuss reviewrnspection with on -site representative? ❑ Yes ro
28. D❑es facility require a follow-up visit by same agency? ClYes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ��o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) XYes ❑ No
3I. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fait to install and maintain a rain gauge? ❑ Yes 1214
33. Did the facility fail to conduct an annual sludge survey? — 0,1 4-0 Ayes [:]No
34. Did the facility fail to calibrate waste application equipment? — doGUM.er �1 es ❑❑KNO
No
35. D s record keeping fCrop,
DES required fo need im vement? If yes, check the appropriate box below. ❑ Yes
Vocking Form Yield Foam Rainfall Inspection After 1" Rain
2O Minute Inspections ❑ Annual Certification Form
p No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
d rttoa ommcnts and/or vvtngs:..•.
._
,.vn,,,,- i .+.z.w.r..sx.' I.i_.S ,::/%...L...:-w.Y� _ 9:....a ._ _ � , _ _. _...,_._,. _._.... _. .. _ .. -... _ .�- � .._. _..- . . _ w L .. ..'�.�.0- - ---- — _ •_ ____ ....-. _.._ - - - •..3.. ...
d3 I,:)eeaZl� ware
31 k-Wl
'$/�/off I•a l�-s N��oo�"��
on -4 I-�o h;
l�A 5 LO CWN f' C S �cheCk,
stax+Pvrap (jhaXrj_X
(�n„p i'�l
.y, 3 m0.i� �'� �ulu.pinq Ih�o `I0 �oyq�Ca►a�.

Vision
ision of ►►'ater [duality
of Sail and ►Pater Conservation
0 Other Agency
Type of Visit D Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit @ Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Daft -of Visit:1211112D43 'Time: 1000
Facility Number 76 [}3
Q Not tl peralional Q Belo%ti 'Threshold
M PerMitted M CeI-6111 d 0 Conditionally Certified ❑ Registered [)ate Last [lperatcd or Aboye'I'hreshold: ......
Farm Name: . County: K-4j0 QJ9bt............................... SN, IKQ......
thyner Name: 13u.Y---------------____-- �hxissszc Phone No: 33ft_14T1=385--------._.-----•-----•-----..
Mailing Addreyt:.9. G ..f?uxk.GIs.sk.l�aAlx..iiU d........................................................... .� l;�Cv�:c.N............................................................ 27.34.1...............
Facility Contact: .Koy..C.hxhmi.................................. 'Title: ................ Phone No: $'19-1.449........................
Onsite Repre%entaliye: lay_Christ:Qi______._.---.-.-.-.-.-.---.-.-._.-._.-. Integrator: Y G.PACYis.EQrn-L%_JnC.------_._._._._.__.
Certified Operat+ir: K.QY-..................................... Cjxri�cuc....... .................................... Operator Certification Number: 1$. 14.............................
Location of Farm:
Farm Location: US [IIwy 220 south from GSO to NC 11r►y 705 east. NC Hwy- 705 east to Fork Creek ,NIi11 Road and turn left. �
ake first right onto gravel drive after Pleasant Hill Road.
® Swine ❑Poultry ❑Cattle [I Horse latitude 35 ' 35 311 Longitude 74 • 4l 35
Design Current
Swine r"an.tritv Pnniilntion
❑ Wean to Feeder
® Feeder to Finish
8025
6773
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Po ulation
❑ Dairy
❑ Non -Dairy
Total Resign Capacity 8,025
Total SSLW 1,083,375
Number of Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area 0 Spray Field Area
Holding Ponds I Solid '['raps I ❑ No Liquid Waste Management Systern 71
Discharges & Stream Impacts
I . is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obser-ved, was the conveyance man-made? ❑ Yes ❑ No
b. ]fdischarge is observed, did it reach Water of the State'? (If ves. notify DWQ) ❑Yes ❑ Na
c. If discharge is observed, what is the estimated flow in gallntin7
d• Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of'past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
11'aste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway [--]Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ------ #f1_l.ower.-----.----._7#2.staged...... . 3.1 llt[ze> s3a - -.Holding-pat d...._..--.-----.--.-----.------.-----.--.-----.--.-----..
Freehoard (inches): 11 21 84
05103101 �jdD (��� Continued

Facility Number: 7hate of Irt-pection 12111120U3
0
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, *severe erosion,
seepage, etc.)
b. 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 polies an
immediate public health or environnmeatal threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of (lie waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
1Vasle Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
❑ Ycs
®No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
1 1. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [ ❑ Yes ® No
12. Crop type Coastal Bermuda (Hay) Small (irain Overseed MaILM (hay)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)? ❑ Yes ® No
14. a) Does the facility luck adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? [:]Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
lb. is there a luck of adequate waste application equipment'?
Rectuired Records & DocumenI%
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available'!
18. Does the taciIity fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problets noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[--]Yes ® No
[I Yes ®No
❑ Yes ® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments [refer to question #): Explain an► 1:F',5 ans►►ers and/or any recommendations ur an► other comments.
,UsC,dra►►ings of facility to tmetter explain situations. {use additional pages as necessary): ® Field Copy ❑ Final Notes
7. Continue efforts to establish permanent vegetation on lagoon embankments.
_
19. Per NPDES permit, must record weekly waste levels on # l and waste pond.
19. Need to calibrate irrigation equipment this year (2003). Don't forget to check sludge in all lagoons by April of each year.
25. The new WUP allows 251 lbs. PAN per acre to be applied on some matua fields if you want to use the new PAN number.
Waste analyses-
1 1/17/03 = 2.1 lbs. NI1000 gal.
IS/ 1103 = LI lbs. NI1000 gal.
�
RevieHerllospector Name Melissa Rosebrock
Elate:
Elate: -
Revie►+'er/Inspec [or Signature4�yLI it k
Continued

Facility Number: 76--04 Il l' In%pectiun 121111211{l3
Odor Issues
26.
Does the discharge pipe: from the confinement building to the storage pond or lagoon fail to discharge at/or below
Cl Yes
❑ No
liquid level of lap;oon or storage pond with no agitation?
27.
Are there any dead animals not disposed of'properly within 24 hour,,'?
❑ Yes
® No
2H.
Is there any evidence of'wind drift during land application? (i.c. residue on neighboring vegetation, asphalt,
❑ Yes
®No
roads, building structure, and/or public property)
29.
1s the land application spray system intake not located near the liquid surface of'the lagoon?
Cl Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fin blade{s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover'!
❑ Yes
® No
32.
Do the flush tanks lack a submerged fill pipe or a permancntltemporary cover?
❑ Yes
® No
Additional Comments and/or Drawings:
05103101

0
Division of Water Quality
❑ Division of Soil and [,Water. Conner►a_ Lion
❑ Other Agency.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit VRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility ,Number wte or Yisil: l 'Dime:
y,( Not [l mratiunxl f3elnw•'I'hreshuld
ICI Permitted Certified' 0 Conditionaliv Certified 0 Registered Date lust Operove T'hreshuld:
Farm Name: .1" �� r7 _. Count►•: b
Owner Name: Toi
!'r Coe_ - r Phone No:
Mailing Address: 4- 2 6 L Lot *- C r2_e L M r` a m VOff-7 �4'
FFacilityCnrrlaet: s �171'' i SCE e— 'Title: Phone No: yr
Onsite Representative-- L4 �]C-� (Z-- Inkgrator: G ur-V Q.zr 'I-rve,
Certified Operator: L .7�, ,� Cp '� !!—Operator C,elrtilirat• n Numbi
[,oration of Farm: �C 1 kA LC�"" ne— Tones q!b' -C 3 1 •
swine El Poultry ❑ Cattle ❑ Horse latitude Longitude '
Number of I,aguans ❑Subsurface Drains Present ❑ 1.a r�on ,%rca ❑ Spray Field Arcs
IIolding Ponds 1 Solid 'Craps 10 No I.ir oid Waste Alana ement S►•stem
Disehart_es &tit_ ream Ininacts
1. is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance roan -made?
b. If discharge is observed, did it reach'A'ater of the State? (If yes. notify I7WQ)
c. If discharge is obscrvcd• what is the estimnted flow in gallmin?
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ)
2, Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or polential adverse impact,, It) the Watcrs of the Stale other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway
Structure 1 �Sttructure 2 Structure 3 5t a •li rc 4 tructure 5
7�
Identifier: t 2- #AlrIA
Freeboard (inches):
0.5103101
❑ Yes txo
o
ElYes
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes I
❑ Yes No
❑ Yes No
Structure t
Confintred
f �

0
Facility' Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures obscrved? (iel trees, severe erosion.
El Yes
No
seepage, etc.)
d. Are there structures on -site which are not properly addressed an&or managed through a waste management or
closure plan'
[If any of questions 4-6,was answered yes, and the situation poses an
❑ Svcs
- o
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance. improvement?
'es
❑ No
8. Does any par[ of the waste management system other than Waste structures require maintenance/improvement?
❑ Yes
y o
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markines?
El1'es
,
Ll�o
�4
Waste application
10. Arc there any buffers that need maintenanceiimprovement?
❑ Yes
Rio
11. Is there evidence of over application? ❑ Excessive Pondi ❑ PAN ❑ Hydraulic Overload
❑ Yes
10
i?. Crop type
13. Do the recciving crops differ With those d •gna Fn the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
El Yeso
c) This facility is pended for a wettable acre determination?
Elo
to
15. Does the rec;ivine crop need improvement?
❑ Yes
16, is there a lack of adequate waste application equipment?
❑ Yes
;Nro
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
Oe/ W-UP. checklists, design, maps. etc.)
❑ Yes
19. Does record keeping need improvement? (ief irrigation. freeboard, waste analysis & soil sample reports)
'es
❑ No
20. is facility not in compliance With any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
{ieI discharge, freeboard problems. over application]
❑ Yes
o
7
_3. Did Reviewer;lnspectot fail to discuss reviewiinspection with on -site representative'
❑Yes
0
24. Does facility require a follow-up visit by same agency?
❑ Yes
�iCo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N�50
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
•i:71'�..�. .� -• .-.._-`. rf:t::+S_:t. •:, .7.-...,say; --r,p.�: .^- ���.
Comments'(refer= to Question#):" iplain any$YES answers andlorany' recorlixnertdations ar any er.rommirnts.':��
Use drawings of facility to better explain situations. {use additional pages as necessary)_ ; Field Cone ❑ Final Notes
`•
L•"a�'�"_«;r�'�:�:s.:�e:�..i`:'e�:_:-a�`.:'.;i��`:�.n:.s��.se+Y.t:�k".4
"'" ' .:rr .. .`.." ._n.r;. ..-re' ��L �Jlr
AL
Reviewer/Ins ectorltia e -:�atv3d%�••'�"+����;��-��������s"�t
p
a.. �.. ... ..ats�w
Reyiewer/Inspector Signature:
Date:
1
05103101 Continued

Facility Number: —Q Date of Inspection 1Q
J
❑r Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon'?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
mments and/or Dravvines:
`3(�03 �. ► Ids. N/ram
a s, 45, PA
(IM4,�
b6de r oco-3)--
10
1
VAY'-.
❑ Yes Io
❑ Yes ",�No
❑ Yes -)�J'N❑
❑ Yes *0
❑ Yes ONo
❑ Ycs )dNo
05103101

Assistance bite visit
Q DiMrbn of Soil and Water ConservationqW
Natural Resources Conservation Service
Q Soil and Water Conservation District
O Other...
Facility Number 75 - ® Date: 123103 Time: 1 13:09 Time On Farm: WSRO
Farm Name Chriscoe Farms
Mailing Address 4262 Fork Creek Mill Road
Onsite
Representative
Type Of Visit
Operation Review
Compliance Inspection (pilot only)
Technical Assistance
Confirmation for Removal
❑ No Animals -Date Last Operated:
❑ Operating below threshold
® Swine ❑ Poultry ❑ Cattle ❑ Horse
County Randolph Phone:
336-879-3585
Seagrove NC 27341
Integrator IN G Purvis Farms, Inc.
Purpose Of Visit
QQ Routine
p Response to DWQ/DENR referral
O Response to DSWC/SWCD referral
Q Response to complaint/local referral
0 Requested by producer/integrator
O Follow-up
O Emergency
O Other...
Design Current Design Current
Capacity Population Capacity Po ulation
El Layer
® Feeder to Finish 8025 4727 ❑ Non -Layer
❑Wean to Feeder
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached
❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees,
❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding
❑ yes ® no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment
❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure?
❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4
Structure 5
Identifier Lagoon 1 Lagoon 2 La on 3 Extra storage pond
Level (Inches) 8 10 1 F_ F48
CROP TYPES IFescue-hay I jHybrid B.G. Matua-hay ISmaii grain overseed
SPRAYFIELD
SOIL TYPES
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

Facility Number 76 - 4 Date:
4/23/03
PARAMETER
0 No assistance provided/requested
❑ 8, Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
25. Waste Plan Revision or Amendment
El
❑
El 10. Level in structural freeboard
26. Waste Plan Amendment
❑
❑
❑ 11. Level in storm storage
Conditional
27. Review or Evaluate Waste Plan wlproducer
❑
❑
❑ 12. Waste structure integrity compromised
® 13. Waste structure needs maintenance
28. Farms Need (list in comment section)
El
El
29. Missing Components (list in comments)
❑
❑
❑ 14. Over application >= 10% & 10 tbs.
30. 2H.0200
❑
El
El15. Over application < 10% or < 10 Ibs,
re -certification
❑ 16. Hydraulic overloading
31. Five & Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
❑ 17. Deficient irrigation records
❑ 18. Late/missing waste analysis
33. Organizelcomputerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
[120. Latelmissing soils analysis
❑ 21. Crop needs improvement
35. sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removallclosure procedures
❑
❑
37. Waste Structure Evaluation
❑
CO]
❑ 23. Irrigation maintenance deficiency
❑ 24. Deficient sprayfield conditions
38. Structure Needs Improvement
®
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Regulatory Referrals
41, Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
43. Irrigation designlinstallation
❑
❑
❑ Other...
system
Date:
44• Secure irrigation information (maps, etc.)
Cl
❑
LIST IMPROVEMENTS
45. operating improvements (pull signs, etc.)
❑
❑
MADE BY OPERATION
4& Wettable Acre Determination
❑
❑
1
47. Evaluate WAD certificationlrechecks
❑
❑
48. Crop evaluationfrecommendations
❑
❑
WUP updated 11/15/02
2.
49. Drainage worklevaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
3
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
®
❑
4'
54. Mortality BMPs
❑
❑
55, Waste operator education (NPDES)
❑
❑
5'
56. Operation & maintenance education
❑
❑
57. Record keeping education
❑
❑
S
58. Croplforage management education
❑
❑
59. Soil andlor waste sampling education
❑
❑
03/10/03

s
•
Facility Number 76 - LY Date: 4�23103
to re -seed the backside of lagoon 1
r dam between Lagoon 2 and 3
:d wooded areas, may add to wettable acres in the future if needed,
new maps for the W UP
aste 3-21-03 Soil 4-10-02
TECHNICAL SPECIALIST 113. Barton Roberson
SIGNATURE
Date Entered: 7/18/03 Entered By: lRocky Durham
A,
3 03/10/03

Sion of Water Quality 0
O ision of Soil and 'Water Conservation
Q Other Agency '
11
(Type of Visit ® Compliance Inspection 0 Operation Review a Lagoon Evaluation
Leason for Visit S Routine Q Complaint 0 Follow up Q Emergency Notification Q Other ❑ Denied Access
acilil►' Number
1,)ute of Visit: I21IW2002 '1• 111c:
F7ti 04
Q Not Operational Q Below Threshold
Permitted ® Certified 13 Conditionally Certified 0 Registered (late bast Operated or Above Threshold: .........................
Harris Name: ...................... ... County. Kwid.Q.1ph ......................................... WSR..3........
t)wner Name:Rcty........................................... 'Chr'j5K. V..................................................... Phone No: M.6:.7.9::3.5AS................................. ..........................
Mailing Address: � fr .>FSr.CIS . x�€ kC. dill.l�� sl.......................................................... 5.v.agrQ.yx.,N.Q ...................................... . 2.73.41 ..............
Facility Contact: ki.RyXbris.cov.................................................'Title:
Phone No:
tlnsite Representative: JRj?y. ht iSlru�.�[td..��G� CX. c�................................. ........ Integrator: .....................
Certified Operator: JR0y.,L..................................... Qjr;6cQ.............. ............................ Operator Certification Number: jjj3.1}Q.............................
Location of Farm:
Farm Location: US Hwy 220 south from GSO to NC Hwy 705 east. NC Hwy 705 east to Fork Creek Mill Road and turn left. #
Take first right onto gravel drive after Pleasant Hill Road. �
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 ' 35 4 =44 Longitude 79 • 41 4 35 «
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
® Feeder to Finish
8025
6873
❑ Barrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
I
I
❑ Boars
E
Design Current Design Current
Poultry ;Capacity Population Cattle, Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer JCI Non -Dairy
❑ Other
Total Design Capacity 8,025
Total SSLW 1,083,375
Number of Lagoons 3 10 Subsurface Drains Present ❑ t.agimin Area 109tipray Field Area
Holding fonds 1 Solid Traps 1 I ❑ No Liquid Waste !Management System
Discharas & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made`? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify I]WQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? [:]Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ® No
Waste Collection $ Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Struclure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldentitier: ..Below.K.hauses.. ....... U apex.af.3....... ...... N iddle..of.a..............Lastra£.3...---...
Freeboard (inches): 18 9 6 120
05103101 r Continued

Facility Number: 76-04 Date of Inspection 12/18/2002
5. Are there any immediate threats to the O'grity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any 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 Aonlication
❑ Yes ® No
❑ Yes IN No
❑ Yes IN No
❑ Yes ® No
❑ Yes ® No
10. Are there any buffers that need maintenance/improvement? ❑ Yes • ®No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Timothy, Orchard, & Rye Fescue (Hay) Matua (Hay)
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ® Yes ❑ No
14. a) Does the facility lack adequate acreage for land application`? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15.
Does the receiving crop need improvement?
® Yes
❑ No
16.
Is there a lack of adequate waste application equipment`?
❑ Yes
® No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
I&
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
60 discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gimmenks {refer to iluc stion #): Isxp - n any YES answers an&' r. any recommendations or ny, other• comments:•_''
llsedrawmgs of facility;:to,f�etter explain situations. (ut e; addhttnnal�pages as necessary}: ❑ Field Copy ®Final Notes
ti a:. s--:__ -__. -
9. Marker on structure #1 looks like the maximum was set with the spillway. Need to check with Randolph SWCD.
_
13. There are some crops in the operator's records that don't match the crops in the CAWMP. Contact technical specialist for any
revisions to CAWMP.
15. Operator plans to re -seed two fields with either bermuda or matua. He has several other pulls that he can use, though.
19. Need to make sure you use the PAN stated in the CAWMP for recordkeeping. Operator had just received his revised CAWMP and
had not had a chance to correct lthe RR-H forms yet.
Operator plans on building a freshwater pond. I ask him to contact the Randolph SWCD for technical assistance or permitting
uestions.
Reviewer/Inspector Name Melissa Rosebrock
Reviewer/Inspector Signature: Date: c�--
05103101 u
Continued

Fsscility Number: 76-04 Da* Inspection 1211812[1[}2 0
Odor sti
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, andfor public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon'?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals Feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional omments and/orDrawings:
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
05103101

tDivision of Water Qualityivision of Soil ind Water Conservation
Q Qther Agency
Type of Visit Compliance Inspection ❑ Operation Review 0 Lagoon Evaluation
t
Reason for Visit Routine Q Complaint ❑ Fallow up ❑ Emergency Notification Q Other ❑ Denied Access
Date of Visit:
Facilit% Number
[] PermittedCertified 0 Conditionally Certified 0 Registered
Farm Name:
Owner Name:
flailing Address:
I•ime: 0�
lot O eratinnal BeloK Threshold
Date Last Operated of ,Above Threshold:
County:
Phone No. i14,'
rd -j QacQme , AX- R� /
Facility Contact: 1 124oll, r 1c } �&Title:
Onsite Representalive: I
Certified Operator: j + i,:x () e j �f ►�
Location of Farm: Lei•
0
Phone No: �
Integrator: i)� Pbcy1.S' Farms-Tnc
Operator Certification Number:
56 Swine ❑ Poultry [:)Cattle ❑ Horse Latitude ' ®• " Longitude ' Fg17-
Number of Lagoons �F ❑ Subsurface Drains Present 110 Lagoon Area JE1 5 ray Field Area' I
Holding Ponds ! Solid Traps �I ❑ No Liquid Waste Management System! -
❑isch, arges g (ream Impacts
1, is any discharge observed from any part of the operation" ❑ Yes 9-N
0
Discharge originated at: ElLagoon ElSnrav Field ElOther
a. If discharge is observed. was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes. notify DWQ) ❑ Yes [:)No
c- If discharge is observed. what is the estimated floes• in gallmin?
d. Does discharge by-pass a lagoon sysicm? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑Yes gNo
3. Were there an), adverse impacts or potential adverse impacts to the (Waters of the State other than froth a discharge? ❑ Yes No
Waste iCollection S Treatment
4. Is storage capacity• (freeboard plus storm storage) less than adequate? Spillwav ❑ Yes XNo
Structure 1 St cture ? StFuc re 3 r' StMJ
� S ctur 5 Structure 6
Idemifier: aZ # 122
Frceboard (inches):
05103101 Continued
:J
i_

0
Facility Numher: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, 0 Yes No
seepage, etc,)
6. Are there structures on -site which are not properly addressed andlor managed through a waste management or
Closure plan'? ❑Yes N�}
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify ❑w'Q)
7. Do any of the structures need maintenance/improvement? ❑ Yes �KNo
li. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes'ANo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �wo
!Waste AVriication
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence of over application? ,, ElExcessive Ponding ❑ PAN ElIlydra0c Overload ❑ Yes No
12.
Crap type 4bl,2
^
13.
Do the receiving crops differ with those design tcd in the Certified Animal W ste Management 4 (AWNV71
Yes
' Nu
14.
a) Does the lacility lack adequate acreage for land application?
❑ Yes
[XN0
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
ElYes
No
15.
Does the receiving crop need improvement?
Yes
WO
16,
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
ltequir(A Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
E3 Yeg P No
18.
Does the facility fail to have all components of the Certificd Animal Waste Management Plan readily available'?
(icl WUP, checklists, design, maps, etc.) ,�
El Yes
PQNo
19.
Does record keeping need improvement'? (iel irrib�ation�. ante analysis & soil sample reports)
❑ Yes
No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility Fail to have a actively certified operator in charge'?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Pcrmit?
y
(icl discharge, freeboard problems, over application)
❑ Yes
o
23.
I)id Reviewer/Inspector fail to discuss reviewhnspection with on -site representative?
❑ Yes
No
24.
Roes facility require a follow-up visit by same agency?
❑ Yes
o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
ElYes
ZO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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): Field Copy ❑ Final Notes
I
Reviewer/Inspector Name r
Reviewer/Inspector tiip;nature:U J Date:
05103101 61. aw PAN) ntrnued
_44� .
L+v 1✓`"Y n C!� �

0 0
Facility Number: --jo Date of Insprclion t 1I [i
14r t
Odor lssue�.
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor belo-w
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there an%- o'idencc of xind drift during land application? (i.e. residue on neighboring vegetation. asphalt,
roads. building structure. anchor public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. NVere any major maintenance problems with the Ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
3l- Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submcrged fill pipe or a permanent+lemporary cover?
❑ Yes No
❑ Yes ))— NNo
❑ l-es 01No
❑ Y-es o
❑ Yes No
❑ )-es \o
❑ Yes Rio
additional ConimenIN andlnr Ora► -in.%
OCJ
05103101

fl Division of 1Vater Quality ,i 0
Division of Soil and lVater Conservation _
Q other Agency r
LLype of Visit Q Compliance Inspection p Operation Review Q Lagoon Evaluation
Feason for Visit @1i Routine Q Complaint 0 Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number 76 [14 Bate III' Visit; 1111912001 'Tiow: 124[I
❑ Not Operational Q 13elow •Threshold
13 11crrnitted 13 Certified 0 Conditionaliv Certified [3 Registered Date Last Operated or Ahnve '1'hreshold: •••-......
Farm name: ChdiCov.farm.................... County: ki�rtd.QIpin............ ..... ........................ !NVSRO ........
....................................................................... .
O-A ner Name: RQy.......................................... C Xr.jSPM..................................................... Phone No: �-#f.7.`1- 5#...........................................................
MailingAddress: .......................................................... Scagro.yvAC................. .............. .......................... Z:7341..............
Facilit►' Contact: B,R]'Xb1f1LsCRe................................................. Cs kt�i�tiar�.l�xrz►s .�nct.........
.......................................................................................... ... Phone No:
Onsite Representative: RocY:.a d.Cbtad.C-4riscpc........................................................ Integrator:N..�i..1'.11x►.'iS..k:i}1Cx17,.�flti,.....................................
Certified [lperator: Sty..I...:iild.Gikald.............. �hx ss►.......................................... Operator Certification Numherj83..Q0_"dJ8;%9......
Location of Farm:
Farm Location: 'fake 41 South - approx. 6 mi. turn right on Little hear Store Rd. This runs into Fork Creek Mill Rd. 3rd +
Jlriveway on left, name on signs.
® Swine ❑ Poultry ❑ Cattle ❑ Horse latitude 35 ■ 33 15 Longitude F 79 ■ 43 28
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
® Feeder to Finish
7300
7178
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilt%
❑ Boars
Design Current Design Current
Poultry Capadty ovulation Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity 7,300
Total SSL W 985,5[1[1
Number of Lagoons 1EISubsurface Drains Present ❑ Lagmin Area jmtiprayFicldArcs
Holding Ponds 1 Solid Traps t ❑ Ntt liquid Waste Management System
1}isrharucs 1&' r cam Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. lf' discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. ]f discharge is observed, did it reach Water of the Stale'? {]i yes, notify DWO) ❑ Yes ❑ No
c. If discharge is observed. what is the esnmaied flow in gal/min?
d. Does discharge bypass a lagoon system? (It'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge front any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
tste Collection & 'Treatment
Is steerage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........#.LLuwcr....................... #2............... ...... -.#3-Uppr-r............HWdi.M,Poxid.... ......................................................................
J
Frechoard (inches): 19 26 13 ISO
f1SIf1,31f11 Continued
,�-d7Iq

Facility Number: 7b—tld � hale of Inspeetion 11/19/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, sevdre 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 maintenancelimprovemen I?
H. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
waiytr-1ptliealion
10. Are there any buffers that need tnaintenancelimprovement?
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [-]Hydraulic Overload
r - r
❑ Yes
® No
❑ Yes
®N�
❑ Yes
®No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
12. Crop type Orchard (Hay) Fescue (Hay) Coastal Bermuda (Hay) Matua
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)'? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination'? ❑ Yes ❑ No
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment'?
Required Record~ & Documents
17. Fail to have Certificate of Coverage & General Permit or ether Permit readily available?
Ili. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis &: soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a acti%rely certified operator in charge''
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe1 discharge, freeboard problems, o►•er application)
23. Did Reviewer/Inspector Fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ Na
® Yes
❑ No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain aii,y,_ answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): ❑Field Copy ®Final Notes
9. Small leak :around Bush pipes at house #3 needs to be repaired. Waste has only traveled 12 inches from leak.
14. Irrigation design was done by Brian Gannon on 9/23/99 and was done on effective acres. Should not need wettable acre
_,
determination since operator has not altered pull patterns or any other aspect of application scenerio.
19. Irrigation design was onsite but waste plan with odorlinsectlmortality disposal checklists was not available. Need to also obtain
aerial photos and emergency action plan and keep these ons'ste with waste plan. Per operator. the waste plan may be at the SWCD office.
19. Need to make sure that "PAN" and "acres" in calculations match the waste plan. Some Spring applications of waste did not have
sample taken within 60 days. fall applications were ok. Still need to obtain soil samples for 2001.
wer/Inspector Name Melissa Rosebrock nwer/Inspector
E
Signature:`-i�1j 4 h ,VA", VA�"X� J Date: 1 i I l n r
0510 3101 Continued

Facility Number: 76-0.1 �e of Inspec'liou 111191ZIlill
Odor ltitiu�ti
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
Are there any (lead animals not disposed of properly within 24 hours'?
28. is there any evidence of wind drift during land application`? (i.e. residue on neighboring vegetation, asphalt,
roads, building struc=ore, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any man jor maintenance problems with the ventilation tan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover"
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yeti ® No
❑ Yes [:IN,)
❑ Yeti ❑ No
7it,y has a waged s.v.vtem. 5tracrure #2 florr.s iiiio #3 b�� gr(ivil)� rutd # :3 flo+v.v iiiro holrliitg potid #4. Waste from haTey'hou,ses I Is intro #1. tV(ist(t.frf)ttt slrricrure #1 is piintped tit) ro #2. Faciliry irrigales orrr of #3.
J
051U3H11

PM
U� Division of Water Quality
Division of Soil and Water Conservation
4 Other Agency
t
peof Visit ompliance Inspection Q Operation Review Q Lagoon Evaluation
ason for Visit )'Routine ❑ Complaint a Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit: k k d 'Time: I�
�
Q Not Operational O Below Threshold
0 Permitted � Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ..i..f .r� .�1- ... Y`rn.................................................... County:..... .a.? ......................
eq........................ .
OwnerName:......... [.[...... r� J Cd........................................................... Phone No:. �.3. ...... .7..L......`.�.�..5 ..................
Facility Contact: ................ D Ca P� ......... Title: .. ..... .. .. Phone No:.......... 6 rl 5JC �.e.+ 4 M C
�C
Mailing Address:... 0�............... � .... r ...e-���I. r ►..1..........�"'. / ..�d.
r�.�r.�...Q. L..... �� �. �.I......... ne+
Onsite Representative:............ ................ •...... Integrator:....................L...................................................... ... N u. .
Certified Operator: .' .'.............. Operator Certification Number.......... .�.... .........
Location of Farm: / T 3o
l.],� t�W Z7-p �� '�"�
"70.�
r e U2. [►��GAll
tf- � r►'7 � Q ■ L..� d-ovl
�� r' �L r.¢.Q.
�
Swine []Poultry [_-]Cattle []Horse Latitude ©'
3S ' �" Longitude �• ® ©
Design
Current
Design Current
Design Current
Swine Capacity Population Poultry
CapacityCipacity population Cattle
C apacity Population
❑ Wean to Feeder
❑ Layer
I ❑ Dairy
I[jNon-Dair-yL---
,
Feeder to Finish s
❑ Non -Layer I
I
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
g a S
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons 3 ❑ Subsurface Drains Present ❑ Lagoon Area ILI Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imgactti
t. Is any discharge observed from any part of the operation? ❑ Yes �o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the con%rcyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. II'dischargc is observed, what is the estimated [low in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2• Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
'�ttite Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Xspillway
Slrue Lire I Structure 2 Stru Lire 3 S ructurc
��}}
Identifier:........... f ..................... .:�...........'..
�.`'•,� Lou;;... .
Freeboard (inches): 96 13 �C�
5/00 1 $ V
Structure 5
❑ Yes ❑ No
❑ Yeso
❑ Yes W=1ffo
❑ Yes tHl- —I"o
Structure 6
Confinued on back

Fadlity Number: ( — b Date of Inspection p
5. Are there any immediate threats to the Integrity of any of the structures observed? (ie/ vees, severe erosion, ❑ Yes f�'"No
seepage, etc.) _ 1
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
.closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintcnancelimprovement? ❑ Yes jaf4o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? D;tfes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JkKo
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes
It. Is there evidence of over ap lication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes _4NO
12. Crop type
13. Do the receiving crops differ with those designated in the dertified A imai Waste Management Plan (CAWMP)? ❑ Yes A-140
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J imo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? 'Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes A110
16. Is there a lack of adequate waste application equipment? ❑ Yes)? -No
Required _Records_& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
D f to had a�mponents of the Certified Animal Waste Management Plan readily available?
(ie WU checklists design maps, etc.) Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) 3?-Ves ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 1WKo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes. No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes 't'No
24. Does facility require a follow-up visit by same agency? ❑ Yes IHo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes fi(No
4 Yi#1a�iQtas:r� d�ec�encie ► re ed d>lrring��;s.v�s�It Yop with Irep 1 q jla tp r
corres' &idence. about: this visit
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); r
S,s JOAL &Qtt� Y&, J 2
1 6/, *PDjut
IX d
w
Rev-iewer/Inspector Name
Reviewer/Inspector Signature. Date: 11119161 $/dp

lI.
4
I Facility Number: '� (� — d Ole of Inspection I 1 I I IR I4
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
. Are there any dead animals not disposed of properly within 24 hours`? ❑ Yes , ' ,No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes)00
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,kNo
31, Do} the animals feed storage bins fail to have appropriate cover'? o
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover? El ym-i4NO
Additional omments and/or Drawings:
wv�.rn�
la/iz/op_ �1= �.3 lbs./iaoo�P.
xr,3
Abd
a °p / � o
4
9
I � • �/�1�1 G /A?T-9,�tP .��.�E W up 6J
/(4�.t.E(�
5/00 fn(r *� 4,�, S Lil CYJ
Q

FEW—
k
■
y DiF'ision of Water Quality
14M Division of Soiland Water Conservation ,
'ype of Visit 0 Compliance Inspection Operation Review Q Lagoon Evaluation
ttiYh
reason for Visit outine 0 Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
]tale tar 1'i.Nil: rr -p i'irrie: r��U 'l Printed on: 10/26/2000
Facility Nuniher 1~ _� { 11C-
u - ❑ Not (1 ierational Q Jkln►y' hre--shold
/J,e.tgtr'rd l`lr•i e'r�l,fav!si!�Operated or 1r"lb11n'e Tlir-esh.oId: ..............
] Permitted irfertiicd C7 Conditionally Certified e.e
arltNaniv: .... ............. (.,unty: ................. ...........................
'wrier Name RpL I.. 5.c4 ..�:.. —
aclllly Contact: .... ...............................................
]:tiling Ilrlrii'css: ..... ..... .��..._........'E` .... e ...'..'..`,A"I1...!1 ..4!.<. ....... C ..........C.�... ................ .3 r .
Iai�e .........:........�. 1.Insitc f�cpresentatiye:c5 [ntc rr',tor r" r, .../�S
■' S L O C'_ I D 0eQ
'ertifierf [llrer;ltrlr:....G > ..... {i.rl...� a�.......................................................... Operalur C:er•tificuiimi... 7.......4 �
,lacatwn nt' f� arrtt: �}� D.,,p%j' � F �'�7�L',� �
R Swine ❑ Poultry ❑ Cattle ❑ Horse
l `'titurlc ®• ®` 3�
Longitude
�• ®' �"
Design Current
Swine Can:acity f'nnuls.tion
❑ Wean in ]'ceder
❑ Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry ( a r:acity' Po ulation Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ other
Total Design Capacity D
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon ,area JEI Spray Field Area
Holding Ponds 1 Solid 'Traps ❑ No Liquid Waste Management Symern
►iseharges tl Strearn Impactti
Is any discharge ohscrved I'tom any parr of the operation?
1
Discharge originaled at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, %vas the conveyance man-rnadc?
❑ Yes c)
❑ Yes n
h� if discharge is nbserved. dill it reach Water of 111C Slate? (li'yt;s, notil'y i}1' O) ❑ Yes 9'K0l
c. ]f discharge is ohsa:rved. what iS the estimalcd llow in gal/mill:'
I
d. Does discharge bypass a lagoon system? (Ifyes, notify 17WQ) ❑ Yes o
there evidence of past discharge front any part of the operation? Cl Yes (� �
^re there any adverse impacts oi- potential adverse impacts let the Waters of the State other than from a dischar.,,�? ❑ Yes fci
G:siec'tion & TrenInienI
olage Capacity (freeboard plus Sloan storage) less thin adequate? ❑ Spillway ❑ Yes EP-<
5lructurc I SrrLit: turo 2 SlruCturc ; Str'uCturr Struciure 5 Structure to
]dentiiisr: !?f,.f.R�.......�(/.......I� t.Ilic?.� C,r...../�i.. /7 I�k ............. ...................
rd f i nehe,}: �( �,' l 9 I.3 ' / 15 r1
It
00 f•eirrrrrturd ora hrrrk
s

Facility Number: — late of Inspection 11-13-0 /40 Prinled inn- 10/26/2000
S.
Are there any immediate threats to loegrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
91(D
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
o
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DlVQ)
7,
Do any of the structures need maintenance/irnprovement?
❑ Yes
Yes
o
8.
Does any part of the waste nianagcrnent system other than waste structures require maintenance/improvement?
❑
n
9.
❑o any stuctures lack adequate, gauged markers with required maximum and in liquid level
Yes
elevation markings?
❑
o
W:rsta; Application
10.
Are there any buffers that need maintenance/improvement'?
❑ Yes
o
l 1.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
o
12.
Crop type SG cc e, fS�&L
yMa-744 . i}
13, Do the receiving crops differ with these designated in (lie (lerlified Aniinal astc f4anagoment Plan (CAWMP)`?
14. a) Does the facility lack adequate acreage liar land application?
h) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. 1s there a lack of ,adequate waste application equipment?
Required Records & Documents
f 17. Fail to have Ccrtilicale of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Man age rnent l'l:an readily available?
Ocl WUP, checklists, design, reaps, etc.)
I y, Does record keeping need improvernew? (ic/ in igation, t'rechoard, waste analysis & soil siunple reports)
20. is facility not in compliance with any :applicahle setback criteria in effect al (tie lime of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, frechnard problems, over application)
23. 1)id Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Z. Io vii}lattgris_or ¢eticiencir�s wire niKed-4kittig Ois-vNit' • You'w011 ree lye rid fl t hi'r
�arresponc�ence: a�aut. thLg .visi#... • . ' . • .. • • .. ' . ' •
❑ Yes
[ frr
❑ Yes
o
❑ Yes
❑ Yes
❑ Yes
o
o
❑ Yes
M411
es ❑ No
❑ Yes
0 No
❑ Yes
❑ Yes
❑ Yes
EJKoT
c�
❑ Yes o
Cl Yes ca
❑ Yes�Ko�
❑ Yes c)
Comments (refer to question #}: Explain'any YES answers and/or any rectimrnendations or any other comments.'
Ilse drawirigs.of facility to better explain situations. (use additional pages as necessary):
c
I&t
'V+
Reviewer/Inspector Name
Reviewer/Inspector Signature:
IN
/ r 4
hate.. 5/00
rr

Facility Number: /_ —04(-1 Date nl' luspection -/ mod/ Printed on; 10/2612000
tklor lssu"-0 W
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation'?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighlx3ring vegetation, asphalt,
reads, building structure, and/or public property)
29. Is the Ian(] application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, ete.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'?
CS ❑ No
❑ Yes n
❑ Yes P,
Vn
❑ Yes o
❑ Yes <)
❑ "'
Yes r}
❑ Yes io
Add
j itiona . comments and/or ings:
Q S Ala
j5;" �.
ILXG(,j
y �
J
5/00

a;
ision of Water Quality
ision of Soil and Water Conservation
Q Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit @ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date ill' Viki1: 1112212i}Illl 'Pilau. 11415 Printedaiaa: 11/22/2000
7f►
— I r
Q Not ❑ erational Q Below Threshold71
13 Permitted [] Certilicd E3 Conditional],., Certified 13 Registered pate lust Operated or Alfra►e'1'hreshrald: .........................
Farm Name: Ckt7-Lmt4-fair.tuts...................... ..... County: 1i�tt�Mph... ...................................... 1!'�4.E UL.......
................................................................. .
OwnerName: K.uy'........................ CKrihko................... ................ Phone No: 3A6:47Y.-3,5#5...................... .....................................
Facility Contact: limy'..[,;farb.coC......................
..................... ...... . Title:.......
Phone Nn:
MailingAddress: .......................................................... ;n:u......................................................... 2734.1..............
{]nsite Repro.sentatir'e:.Klty..Gh.slid.V.
........... ...... ........................... .. lnteg,rator:IY..�.ij'.ttry6.l?.mans., ITic:......................................
CertifiedOperator:Rj)y.......................................... xiSSlte........................................... Operator CertificaIion Number:lti3.i?.U.................... ....
......
Location of Farm:
Farm Location: Take 41 South - approx. 6 tiai. turn right on Little Bear More Rd. This runs into Fork Creek Mill Rd. 3rd �
iriveway on left, name on signs.
® Swine ❑ Poultry ❑ Cattle ❑ Horse latitude 35 ' 33 154 Longitude 7'J • 43 ' 2?i11
Design Current
Swine C'anavity Pomdation
❑ Wean to Feeder
® Feeder to Finish
73(H)
7910
❑ Farro", to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Resign Current Design Current
Poultry Ca ac.ity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Nan -Layer JEINnn-Dairy
❑ Other
Total Design Capacity 7,300
Total SS L W 985,5(
Number of Lagoons L ' .J ❑ Subsurface [)rains Present 110 Lapican Area IN Spray field Area
llolding Ponds 1 Solid Traps f ❑lira Liquid N%'atite ,1lanagement System
DischarM &C Stryam Imparts
1. Is any discharge observed from any part of the operation?
❑ Yeti
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. lt'discharge is ubserved. was the conveyance man-made?
❑ Ycs
❑ No
b. If discharge is observed. did it reach Water of the State'? (If yes. notify DWQ)
❑ Yes
❑ No
c. If discharge is obseiwed. what is the estimated flow in gal/min?
d. ❑ores discharge bypass a lagoon system? (If yes. notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation`?
❑ Yeti
® No
3. Were there any adverse impacts or potential adverse impacts to the Water~ of the State other than from a discharge'?
❑ Yeti
® No
Waste Collection &, Trcatmcnt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
®No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure h
Identifier: .......... Al ......................... #?.upper:.. ....... ........ #3..latees......... .... Hot.dsng.pand.... .... .................... ............ .......
...... .......................
F-rceboard (inches): 30 3(1 24 109
5/09 5 9
Continued on brick

1Vac'ility Numbcr: 76-4 Date of Ills pectinrt 1111212{lll{i I'rinlcd ori: 11/22/2000
5.
Are there any immediate threats to the iil f ity of any o1' the structures nbtierved? Oe/ trec�vere erosion,❑
Yes
®Nu
seepage. etc.)
6.
Are there structures on -site which are not properly addressed anchor managed through a waste managenicm or
closure plan?
❑ Yes
® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yeti
® No
8.
Does any part of the waste management system other than waste structures require innintenance/impro�ve[lien t?
❑ Yes
® No
),
❑o any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'!
❑ Yes
® No
Waste 1 imlicatioi
10.
Are there any buffers that need inaintenancelimprovement?
❑ Yes
® No
11.
Is then: evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ hydraulic Overload
0 Yes
® No
12. Crop type matua and orchardgrass
13. Dig the receiving crops differ with those designated in the Certified Animal Waste Management flan (CAWNIi')? ® Yes ❑ No
14. a) Does the facility lack adequate acreage For land application? ❑ Yes ® No
b) Does the facility iieed a wettable acre determination'.' ❑ Yes ® No
c) This facility is pended for a wettable acre determination'' ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired R['o'ords_4�_llaruntenls
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUI', chcckIisis, design, maps, etc.)
19. Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'!
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(icl discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review•linspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWN111?
la.
N6. 6lationis;or dericiencies were noted during -this: �isiL'Y{iu:w•ill receive-ntihirther
i tirrespimdenee.:ibout this.► isit.
ow��3r-aaP�.-: a �qy r. i�i -: '�a; arar--• Y �..s.-.�va.ww•.:i._ ���.:r� •.»� �-..,. -
[_iimritents,{refer-An ques(ion:#} ,Explain ani•��,ES answers anolJor„any recommendations orr;anr iitFier•cnrii
UsCdE c�i+in s uF fa li hoc lFr e�c lain` i uatinns, 'dd tf1Ra1 _i cs a -
€:. tti s1 _ e . P (use a _ p• g cam. arv)!r �. , � 1-•:..r
❑ Yes
® No
❑ Yes
®No
❑ Yes
❑ No
❑ Yeti
® No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes
®No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
). Will need to designate top of dam on marker when permitted.
19. Putts #9 and #10 have mama, orchardgrass and Fescue. WUP only lists fescue hay. WUl' needs to he revised if possible.
19. Pull~ i l and 14 have matua. orchardgrass, and oats. WUP lists an overseed of with coastal bermuda hay. WUP needs to be revis
f possible, to reflect actual field crops being used. WUP also needs to state application months ..... I could not locate this in the WUP.
Z7, Animal~ are picked up every other day (approx. 36 hrs.).
waste sample by Dec. 7, 2(H)0 for most of Fall waste applications.
4J
Rer'iew'erMnspector Name Ntelissft Rosebrock
Reviewer/Inspector SignaturcV jMjpjjAM _ 11v, O ,,SA, Atl _r hate: j t l e9zl N,) 511N)

,Fac11it►`Number: 76-4 I iof' Inspect inn I11Z212{IIl{I I'rinled rrn: 11/22/2000
t) for Is" i -s 0
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agilation?
27. Are there any (lead anitnals not disposed of properly within 24 hours? ® Yes ❑ No
29. is there any evidence ol'wirid dr'i1t during land appIicalion? (Le. residue on neighboring vcgetation, asphalt, ❑ Yes ® No
roads, building Structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan{~} noted`? (i.e. broken fan belts. missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Conuncnts an[ ur rsvFings:
Notes regarding permitting:
Loan for additional houses for 8020 signed March 1994.
Design for 2000 ~wine dated 12/2/97.
Martin Brothers Started construction prior to 12/1998 since first payment was dated 12/28/98. Jerry Craven -contractor.

ivision of Water Quality
/❑ Division of Soil and Water Conservation
❑ Other Agency,
of Visit Q Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint a Follow up Q Emergency Notification Q Other
Facility Number Datc of Visit:
[l Permitted Certified ❑ Conditionally Certified ©Registered
Farm Name: ............J...,b rL��--i.� e:e oe .....F .�. .... ............
......................
Owner Name: � h n 5 e oe
b..............[.............
......... ...................................
......,
Futility Contact:a C �� V'ii Title:
...................................................... .........................
;Mailing Address:..... � . a L.r..�� ....f� �...l.l......,
Onsite Representative:
Certified Operator :V
Location'of Farm: t
L, • cA r15cCP--
%5
W y a�o�Q 56 u-0
05140 For !/- A rP.e K-- rM i 11
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude
Design Current
-OWU e
Wean to Feeder
Feeder to Finish
Farrow to Wean
= ❑ Farrow to Feeder
iy ❑ Farrow to Finish
Gilts
Boars
❑ Denied Access
Time: D Printed on: 7/21/2000
❑ Not Operational ❑ Below Threshold
Bate Last Operated or Above'Threshold: .........................
County!' .���..............................................
Phone No:
a�].................................
Phone No:
1-6 10e-
tR n 4
Integrator:
O erator Certification Number:......
r l Ff�t r i5 an rI Xh
�" Longitude • ' At
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
; �. Number of Lagoons ❑Subsurface Drains Present ❑ l-ag—n Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Strearn Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is ohser�ed, was the conveyance man-made! ❑ Yes ❑ No
h. If discharge is observed. did it reach Water of the Siaie? {II y'es, notify DWQ) ❑ Yes ❑ No
c. II'discharge is ohsorved. what is the csdinmed flow in gal/min'!
d. Do --%discharge byltatis a lagoon syMem? (Ifycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes km)
o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ,r El Yes x No
Stcturc I 5lhi.turc 2 truclu c Structure 4 "f , Structure 5 Structure fi
Identifier:....................................................�r... s:Y.....�.....�t`j...p�;�C�,................................
I�rechoard (inches): 3 IV�
5/00 y Continued on back

Facility Number: — [ ii' lntipectiun J�JvL �Q�'] Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the story a pond or lagoon fail to discharge at/or below EI-Y-es—B-No
liquid level of lagoon or storage pond with no agitation'? 1 r '02004
27. Are there any dead animals not disposed of properly within 24 hours? Yes [:1 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building Structure, andJor public property) ! j
29. is the land application spray system intake not located near the liquid surface of the lagoon'! ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover'? (,` �'j� , T- G2ID CY3 -[9-Y4"[. .No
ttrttt�
pje,S: I,OhanS ia3oo'n ul�r
i + ?
KDroJari orn i
�r�11 1 t iqq �1
Noh5' Coln for &dC�i jov� � �'�b'�LSpS 167r�d�C7 Sf a��
�o � � arch � � �
psi n For jq-o60 5 :, n lobed Idf 4q 7
fl•
M n +r&46-tr5 Si%Lr�e J e ovi5+r uc:4o r I r 4-
r �f I cog 0
J
�0' TOJMLA+ 40,fea
P00111 f;�1Q5 fV�ct�{-areBio�zl= sol-s. C+n'i+e LOU
iis�5 Ctn over -seed uY Zbasiu ( hvmuda-h� e
INuP needs +a>
Qfie4 s�e+,xa(
LOU 0 need5 Ck
lie �-"lY-At if pelssl b �,q-o
Vicki b6nj osed .
Mv-`� t- qP1'6 ( i On j?I!D 5 C LSD
L,605* "-AAtpo y .
.I
rMA

Facility Number' 6- Date of lospcc:tion 010 Pria(ed on- 7/21/2000
5. Are there any immediate threats to the t�rity of any of the structures observed:! (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes A
No
Waste Application
10. Are there any buffers that need maintenancelimproverent? ❑ Yes No
11. Is there evidence of over application'? []Excessive Ponding []PAN ❑ Hydraulic: Overload ❑ Yes No
12. crop type �Gl �� �jA t . r e in t �W:. iti ►-pit, 5°� .,. ,,. _ _ � �,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)'?
14. a) Does the facility lack adc(luate acreage for land application'?
b) Does the facility need a wettable acre determination'?
0 This facility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
I& Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. [hies the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
{ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with nn-Site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Nd-viola#ioos;oir d�#icier�cies ry re noted dtrritig thjs'visit- • yoji'Willi•[; e'oh,,6 fib futfte
Corres pride' 'e' ah'; A this visit.:. :: :: : :
XYes ❑ No
❑ Yes'TIo
❑ Yes allo
[r
❑ Yes No
❑ Yes No
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):
❑ Yes A No
❑ Yes No
Yes ❑ No
❑ Yes o
❑ Yes YNO
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes *o
Ab
tip d c{ ►'1'1 C 11 VVI cx� (L (,L: k�P
1 M CA. {JcJlr'� �) �: �.[ .� [ � r!' l� t
a ors,&rd�- P scOe 00 it up 0,n t
S c��,5� h i 0, ', _hl lei o . rem 15 e. c1.
Reviewer/Inspector Name AGA I _�i,5 L V_f 1s,&b V- 6r
Reviewer/Inspector Signature:')fy{ I P1 Jj +14-_ fAJAVt7 J)/ /)Z-!rJ Date: / 1 / 7J, 1 f)U 5/00

4
t
0 Division of Id AV:iter Consc6-.' 66n Operation. RJ r ` �` `-
_n qH JR
E3 Division of:. - •nd 11':iter Conser►:itiori Cnm Iiance,Irisp. .i pn•, i �• .[�. Depif
•1
�`.
f 3 ,. •� !] 'sion of Water unlit - Corri Iiance Irps eckion a•:' !;�` rt'.' "i':.�JUN
• `., t C Agency CnGu t•.
�� ey. t�pt.� ... ... .�.-. w:?' =�'i �e .=.'ivy. ..�y 4: •.. I:!.� .. .. ... .... .. ��'k' �•�. ^. .. �,p� "r F.VVY
Uthe - n'Revie �,
r:
0'Rotitine. Q Com plaint D Follom,- p p of My inspection 0 I''e111o►1'-ti of DSNVC revieN' 0 01her;,,�
Facility itiuitther
Date of Inspection
Time of Insperlion d pjt, W hr. (hh:inm)
0 Permitted [] Certified © Condi(it)nally Certified 0 Registered 113 Not Operaationx! Date Last Operated .
I'';irit, N:itppe: .C..f[[jj�l.`'..t/' ............ (_Utiiit
0,►-ner Name:-....L1.0 1'(.S£t+E
.......................................................................
Fac-ilily Contacl: ...Ab..t1/......Ni. 0. :............. ........ .f'itle:
ylailinf Address: ►fV`�5.......�+ ......�...il� Ald ...
Ousite Re resvm1atre: '
.....................[r4
(erlfiecOperator: ...Localion of Farm: rn.. 'r _ _ .r I
Phone Nn:.:• , 31•�.: .... ra?%7y.. .:arR5
Integrator: NG „P.{�Ur• 1-ArnS
Ye.;at............ .o..
Uperator Certification /Number:..L�� i '. ......L4 �
E L1kSr.*
Latitude =• =° ®" Longitude �• ®: ®6 1
i�
' Design Current ' ; 5... 1)csitii:;" : Current Design Current
swvinc - Capacity Population Poultry ._ Ca arity 1 opul.ttion .Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
Q�
❑ Farrow to Wean
❑ Farrow to Fccdcr
❑ Farrow to Finish
❑ Gilts,
❑ 13oars
LA
❑ Layer 10 Dairy
❑ Non -Layer s: ❑ Non•Dairy
❑ Other
nTotal I)esigh c.tlmcity paS�
•Total SSI.W
�[ Numher:6f;La =arms • a ,. ❑ Sulnurl-ice Drains Prescnl ❑ Lagoon Area ❑ Spn.q Fieid Area
Ilolding fonds l 5olid•Tralps r.� ❑ No Liquid Waste Management System I -.
l__ !�
Disclpar es & Stream Imlpact,5
f. Is any discharge observed from any part of the operation'?
❑ Ye
c:
Discharge ori'-Mated sit: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance: man-made?
ElYes
ElNo
h- If efischargc is observed, did it reach 14'ater of the Stale? (If ycs, notify DWQ)
❑ Yes
❑ No
c. ll•clischurgc is ob.wrveef, what is ilic e:siiutatc(itic)w in gallinin'!
d. Does discharge bypass a lagoon system? (Ryes, notily DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
cp
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
o
Waste Collecti[pn alntent
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
L<o
Structure I Structure 2 Structure 3 Struct re: 4 Slrus litre 5
Strucuire b
Identifier: J�l�LIL1RI��r. I�Iir�- NI RIkejo— I-KIbAfker
Fre e hnstrd (inches : ................ 34)1 -...... 7 ..
5. Are there any immediate threats to the integrity of any of the structures observed'? (icl trees, severe erosion,
❑ Yes
f�'Ivo
seepage, etc.)
3/23/99
Confin tied on back

r + .
P:u'ility i�iumla,+r: 6'1O)f' I IispCeti o,F
G. Arc Ihere structures cm -site which are not properly addressed and/or managed through a waste rmu,agemenl or
closure plarl? ❑ Yes , o
(If any of questions 4-6 w'as answered yeti, and the situation hoses an
immediate public health or environmental threat, notify DVVQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes , o
S. Does any p:,rt of the waste management system ether than waste structures require IT] aintenancchniprovemen1? ❑ Yes o
9. Do any siuclures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings`? ❑ Yes 2<0
Waste Application
10. Are there any buffers that need mainlenance/improvement? ❑ Yes 5;'
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes 9110
12. Crop type CC5r_a_e_ M47-4,.4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management flan (CAWNIP)? ❑ Yes Vo
14.:t) Does the facility lack adequate acreage for land application?
❑ Yes
2<1
h) Does the I'acility need a wettable acre determination?
❑ Yes
c) This facility is pended fora wettable acre determination?
❑ Yes
140
15. Does the receiving crop need improvement?
❑ Yes
o r
16. is there a lack of adequate waste application equipment?
❑ Yes
Q No
llcquired Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
Yeti
❑ No
18.
Does the facility fail to have all components of (lie Certified Animal Waste Management Plan readily available`+
(icl WUP, checklists, design, maps, etc.}
Yes
❑ No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20.
is facility not i11 contpli:Ince with any applicable setback criteria in effect at the time of design'?
❑ Yes
04 o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ir?<0
22.
Fail to notify regional DWQ of emergency situations as required by Genera! Permit?
��
(ic/ discharge, freeboard probients, over application)
El Yes
1;1
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a fallow -up visit by same agency?
❑ Yes
o
25•
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1
Nii yR)E i ttiris o� - i1� f ieiencic •�v(,, a noted. 0iifif g phis; visit' - Yo W it I rceciye fiti file hi r.
gotresnolide, 'e. bi)kthi5,'sit'•.•.•. .. : :.'...... .
Conilitc, refei to [ uestioil # : •Fx ilain aii V E S,aas►4 rs an&6oi it}•`reconiniendations riPany'othcr eornnlenfs;
[ l ) l y _ y
ilsc;dra►vings:of facilit: v;to lictter:.erplairi sttllatioIlS.�41Se ad(Itlanal pages as'neeessury)::
... - .... .. -. a. :, it ': Y,'d.... ..i"!�: ...a..x :2
A.
] % G/ M. � /I45 be_GA.1 'ql to C `� •' oL4� Al, 155 �t c cr e Y .
1 ,
I4 W A- 5 #V o +t v.� � . 1�L A 6 f1 r AJ 5 0 ec�. a
�i� [.� w r �I � r cr G �fi+tJ�D w3 rji Gl +'�- ���� � Y " � ■
IF
Revie►rerllns ieetc,r Nalne ,,' r ,...,r z', Vi• a+..
l .. � +, �%�_�. M1 � Ac a�� .. �---• '- O' [� tlb ' ., ppgi".�I`� � �i7c. t��n'• . � 444.^` :i+k: ✓ iR��.
Reviewer/Inspector Signature: C Date: �a ,7
3123199

Facility Ntimlacr: Il l' inspection
Odor issues
26. /Jens the discharge pipe frorn the confinement building to the storage pond or lagoon fail to discharge at/or below Q111111's ❑ No
liquid level of lagoon or sturagc pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yesiu
28. Is there any evidence of' wind drift during; land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Na
30. Were any major maintenance problems with [lie ventilation fan(s) noted`? (i.e. hrokcn fan belts, missing or
or broken fan blade(s), inoperable shutters, ctc.) ❑ Yes [
31. Do the animals feed storage bins fail to have appropriate cover'? ❑ Yes 4)
32. ❑o the flush tanks lack a subinergcd fill pipe or a per manent/temporary cover? ❑ Yes yin
r c itiuna omments an[ ❑r' ra"y31w::: r `'. ' l '`�w `�' aia i ir;a` '.'# F a 3 i �r � `"„; `. i=`:' ._'- Sa at!
R

J
IN
E1I)ivisicin'6f riil^ �►'ate'r�Conservation --Operation Review'
13
,s )Nision'USoi� Water.Coriservation sConililimicc Inspeew
f �3f
:[ltvtsrru>< nfaVVatcr.Qualify - Compliance lnspection
O Other iAgencv-- Operation Review
14D Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other J
Facility Number 7h il4 hate of Inspection 11/8/99
Time of Inspection 1[13U 24 hr. (hh:mm)
0 Permitted 0 Certified 0 Conditionally Certified ® Registered 113 Not O erational Date Last Operated:
Farm Name: Chdactre..F.arxin.......................... County: R andulplx...................................-- ... !YSX, Q........
........................................
Owner Name: Ru . Chriwc►c......................... Phone No
Facility Contact: H.Q.Y . 3tt'isc:stc...................................... ..... Title: owilor...................... ............... .............. Phone No: 3M::$.7.�.:3 f35.......................
.......
MailingAddress: ......................................................... Sxagrrrve.NG......................................................... 273.41..............
( lnsite Representative: I�Six.L:ht i5f ot...................................... Integrator: fY..�..iurxis.k.ax.,.Inc,.........................
Certified Operator: Hal ...................................... Uldhrmv .......................................... Operator Certification Nuniber-.J.&�.QQ .............................
Location of Farm:
k:�txt .Location �... {:�akc .4.1. �rtlt3x.-.aup� x,..b.xr�(,..t�ur.�n.xi�k��.un.l�ittls.If.� ar. turc.li ,...� h�i .xutas.xot srxk..rKxcc l�.i�1.i11.k;dA. xd...... A.
:..4.Ck.1Sx,.msf.ipt.11.1151',.......................................................................................................................................................................................................
Latitude 35 • 33 l5 Longitude 79 • �l3 28
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
® Feeder to Finish
73M
7042
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JE1 Other
❑ Farrow to Finish
Tolal Design Capacity
7,100
❑ Gilts
❑ Boars
Total SSL W
985,500
Number of Lagoon~ ❑ Subsurface Drains Present I&Spray Ftcld Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management Svstem
[)isehargjLs & Stream Impact
1. Is any discharge observed from any part of the operation'? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Ficld []Other
a. la discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. It'discharge is observed, did it reach Water of the State'? Of yes, notify DWQ) ❑ Yeti ® No
c. if discharge is observed, what is the estimated flaw in gal/min?
(i. Does discharge bypass a lagoon system? []ayes, notify DWQ) ❑ Yes ® No
2. 1s there evidence of' past discharge from any part of the operation'? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ® No
Collection & Trgatnieut
4. Is storage capacity (freeboard plus storm Storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ............... 3$ $U. b 9
5. Are there any irnrnediate threats to the integrity of any of the structures observed! (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on buck
Printed (in 11/8/99

Facility Number: 76-41 [late tipeetiun
6. Are there structures on -site which are not prf ly addressed and/or managed through a waste9agenlent or
clOsin'e plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovetnent?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlicatioti.
10. Are there any butlers that hued maintenaricclimprovement?
1 1. Is there evidence of over application'? ❑ Excessive Pending ❑ PAN
l 118199
❑ Yes
® No
[:]Yes
® No
❑ Yes
® No
® Yes
❑ No
❑ Yes
® No
❑ Yes
® No
12, Crop type Fescue (Hay) orchard grass matua
13. Doi the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yeti ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c} '1 his facility is pended torn wettable acre determination? ❑ Yes ® No
15. Does the receiving crop neat improvement?
❑ Yes
® N«
16. Is there a lack of adequate waste application equipment?
❑ Yeti
® No
Rout i_r • lRe .off & Documents
17. I -ail to have Certificate of Coverage & General Permit readily available`'
❑ Ycs
® No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe1 WUP, checklists, design. Hasps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard. waste analysis & soil sample reports)
❑ Yes
® No
20, Is facility nett in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
® No
21. Did the facility fail to have a actively certified operator in charge'?
[I Yes
®No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(icl discharge, freeboard problems, over application)
❑ Yes
® No
23. Did ReviewerlInspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
® No
24. Does facility require a follow-up visit by same agency?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
®: N[i viir,latii>'ns or deticicneie5 were ncrteil:durin -this Visit. N6u4ill r&cive,h6-further': •
etirres nriden& ahioitt this.visit. • '
i iiuiicnts [r questic n #) Is plain any' YEST r�pers an(iktr :rny rcenmmen[4aiiiin r..any other co`ommments , AU.wdrW
E.sn.�fit-int s�n�acrIij7 better: explain situations. {use additional
as necessary} ".:
l
pages
.
) - NRCS to set markers soon.
18 - Certification should be completed soon.
ff
Reviewer/Inspector Name Iw, Corey Basinger
Reviewerlluspector Signature: Date:
on 11/13/99

0 Division of So Water Conservation - Operation Revie
[] Division of Soi. ,d Water Conservation - Compliance Inspec on
-Division of Water Quality - Compliance Inspection `
Lj Other Agency - Operation Review
Routine D Complaint ❑ Follmv-up of DWQ inspection Q Follow-up of DS%VC review Q Other
Facility Number 71,a slate of Inspectiuli /
l'inzc of Inspection ; O 24 hr. (hh:mm)
© Permitted 0 Certified ❑ Conditionall►• Certified Registered 0 Not U erational Date Last Operated:
Farrn Name: r t $ cOc �1r-m.s County:.. ! 7
4„r...................................................................................................................... t?..� t...............-.--........ <ri .7....
Owner ;dame: �!�. �� rt. S Go �-.. Phone No:...,��
FaciIit► Contact: ...... .r....................... Phone No Title:....�.W 33G
Mailing Address: 42�Z r�rzk' �'LP�t- /2�] 1 j ��G� Yam' �C� 3��
I....��...}...................I.............................................................................. ..,.... fer!...............................................-..... .....I ..........
..........
Onsite Representative:...IGD. nS ,g ....................... .. Integrator:...l..` .... 1�`�►.}.. � !�25 ...IIY ......
Certified Operator: _ .. �l`l. o Q............................... Operator Certilicatiun Number: .....��..............................
U e
d.. 3D 0
Location of Farm: (f6 c]t D 166(lq
- ......lr....rT .1F`�!�k a... �. .... �fT1 e. �:......... ...f!.�,��1 .. A!R.... f+ '.1'..G d?P. r .............. ....�" t... {f'H.S........ r/
��--.....ter.......�?-:►.�w�??�...a�:+...1�.�'�.:.................................................................................................
t.atitn[lc 3� • 33 ` �" Longitude F 7r • 4-3 -o "
Design Current
Swine Canacilv Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Bo'u-s
Design Current Design Current
Poultry Ca acit y Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 667—
Total SS L W
41Vumher of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Sprays Field Area
Holding Ponds / Solid Traps ❑ Na Liquid Waste Management System
Discharges Zit Stream lmpacLs
1. Is any discharge observed from any part of the operation? ❑ Yes 2Rio
Discharge oriainatcd at: ElLagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance lnan-made? ❑ Yes V No
h. If discharge is olnct'ved, did it retch iValcr cif the Stale'? {iCycs, niriify D11'Q} ❑ Yes N:N❑
c. If discharge is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes '®'No
2. Is there evidence of past discharge froth any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 5j'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes 5?No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..............-�. �.....................7.............................. ............................��. ...................................................................................
5. Are there any immcchate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3123/99 Continued on back

Facility Number. :*-- &4- 0
1]:�fnsprction I II/YII�
6, Are there structures on-si(e which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �dO
(If any of questions 4-5 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
9, Does any part of Iltc waste. management system other than waste structures require rnainicnarice/irnprtzvement? ❑ Yeti KNo
9. Do any stuctures lack adequate, gauged markers with required maximurn and minimum liquid level
elevation markings'? ,KYes ❑ No
Waste 1Ir1ttlii'utinn
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2rNo
1 I . is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes (g No
12. Crop type FO-cLC/6 Drc 0"'I Gmvs
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes js;�No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ON❑
b) Does the facility need a wettable acre determination? ❑ Yes RNo
c] This facility is pended for a wettable acre determination? ❑ Yes tgNo
15. Does the receiving crop need improvement? ❑ Yes 191NO
16. Is there a lack of adequate waste application equipment?
❑ Yes Wo
Reut ired Records & Documents
17. }ail to have Certificate of Coverage R. General Permit readily available?
❑ Ycs ® No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WU11, checklists, design, maps, etc.)
❑ Yes ❑ No
19. Docs record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes Jj;'IVo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ErNo
21. i)id the facility fail to have a actively certified operator in charge'?
❑ Yes EVNo
22. Dail to notify regional DWQ of emergency situations as required by General Permit`?
(ic/ discharge, freeboard problems, over application)
❑ Yes MNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes JR No
24. Does facility require a follow-up visit by same agency?
❑ Yes E'Na
25. Werc any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes R'No
�iiflitti+itis :r ililficiencies were nilrted- clit-i 19 #his'. I I Ynt�r :rvitl reeciyr ilia further
. - cori-esi)6iideh(ie. abirtit. this Asit� :. ...... ; . . ; . ; ..........
Comments (refer to tluestion #): 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):
y 1%)" C - se- - pArtr 6 rS Sc-,r1AJ .
419 t�Qr� i-F; criv� t o� 5he4ld ba c.pr" P 1 O_R 1
][;e►ierverlInspectorName L.lJ��`% �4:s.1Ad•,5ri?
ReviewerAnspector Signature:
Date:
3/23/99

Facility Number: il:iirltipertirm ii
Odor Issiecs
26.
[noes the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation'?
27.
Are there any dead animals not disposed of properly within 24 hour%'.+
❑ Yes
.F?!rNo
28.
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
CR No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
29"No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
'KiNo
3I.
Do the animals feed storage bins fail to have appropriate covcr?
❑ Yes
9No
3/23/99

p Vivision of sou and w Conservation - Vperauon Kevrew
p ❑ivision of Soil and NOW Conservation - Compliance Inspection
Division of Watcr (duality - Compliance Inspection
p other Agency - Operation Review
notine 0 c.omplainI D rnno►►'-np of It►vij InSpec IIoIt 0 r❑
F:lcilil► Number
0 Registered p Certified p Applied for Permit p Permitted
►►'-up of 111N►L. re►'le►►- 0 [.11her
Irate of IovVVlion 10123/98
Tinle of Iratillcclilm © 24 hr. (hh:min)
p I of perahorr;I Date I,.Ist Operalvd:
Farua Nanac: Chrisme.Farins....................... ... Copal►': Randolph WSRO
................................................................... .
0isIIvr IN aIIIC: Hod' ........................................... Cb]Cisco -........................... .. Phone No: 9.10-87.9.-3585...... .............. ......... ............
1 :Ic'ilit► C:orllllc•t:Ruy—Ch.riscac............. .... ...... ..... I ......... ... ... ...... I"ills: Owner................................................. I'llurle -No: 336-.819-3585 ..........
Mailitl- Address:: 11262..1!.ork,.Creek..Mill.l3t1................................................................ 5ca€1ruxe.N.0...................................... .................... M4.1...............
Onsite Represcnt;ali►•e: Ray..Christ[r.............................................................................. III trt;r:aurr-: a....uC1:I5.. aYIi1�,.111C.....................................
Ce0ificil 0Ile r'aIor: R uy..L................. Clkriscae................... 01IVraIor Ccrlitic ation IN' unllie l.
LocaI ina raf l' n rill:
Swine Capacity Population
p Wean to ]-ceder
® -ceder to Fin is
p Farrow to can
p Farrow to Feeder
❑ •arrow to Finish
p Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
Lq_Layer p OalTY
Non -Layer I 1 113 Non -Dairy
f7 Other
Total Design Capacity 7,30
Total SSLW985,5=
Number of Lagoons 1 Holding Ponds r_�
❑ S u
bsue are
D rains
11 resent
Q Lagoon Area
N Spray Pie
❑ No
Liquid Wasic
Mariagenjent
. ystcm
L`rnVral
1. Are there any buffers that need rnaintenancelilliprclvenieitt?
C3 Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
17isch:ugr c,ri��inalyd nt: p Lagoon ❑ Spray Field ❑ C]ther
n. If'dischaI e is observed. ►►•as the conveva11cc man-made'.)
❑ Yes
0 No
h. II'd ischar--e is abserved, did it reach Suri�cc lhalcr:' [il }�s, nntifj C]G4'(}}0
Yes
®No
c. It'dischar-r is observed. ►►'flat is the estiillaled How ill �-- al/Illlil?
(1, lines discharge bypass a fagocan srslenl'' {lC}cs, notiti Qll'Q)
❑Yes
®No
3. is there evidence of past discharge from any part of the operation?
❑ Yes
®No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
S. Docs any part of the waste management system (other than IagoonslhoIding ponds) require
p Yes
®No
maintenance/improvement?
& 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

acl t y Number- 78_04 l};uIv of Ole I w 11
8. Are there lagoons or storage ponds on site which need to be properly closed? p Yes N No
ti[rIICltrITS (l.a�,ml11s,HnldiilU I'uncls. I'Illsh 1'ils, (Itr.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes M No
tilruclure 1 'Iructure ? Structure .1 structure 4 structure tilructul-c 0
Idcnliller: #1 92 #3 #4
Freeboard(ti ):............... a................. .... .......... L.5.:............. ............... 1_S......... ...... ....aRmast..etn}]fj........................................ ...............................
10. Is seepage observed from any of the structures?
1 1. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate puhtic health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Wasik- ekphlirnlinn
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify 1)WQ)
15. Crop type .......................E,t: ic=...................... ......................... F y.c.............................
16. Do the receiving crops differ with those designated in the Animal Waste Management flan (A WMI')?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
lei. 1s there a lack of available waste application equipment`?
20. hoes facility require a follow-up visit by same agency?
21. Did Reviewerdnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
I or• Certified or Per millvd t'nrklntc. Onl►'
23. Does the facility fail to have a copy ofthe Animal Waste Management flan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWM1'?
25. Were any additional problems noted which cause noncompliance of the Permit?
t nyio t tions.or ieimenct.es.WCM-natc : unng t his ti is na. will.reueive ntr urt er .:.
�.4e)^regjj[in�i�tje� ;t�ltl� .t�li5�'1'i5i�:. �. �. �. �. �. �. ..................
(]Yes ® No
p Yes ® No
p Yes ® No
® Yes p No
El Yes ® No
p Yes ® No
CI Yes ® No
p Yes ®No
p Yes N No
p Yes ® No
[3 Yes ® No
[3 Yes .NNo
p Yes ❑ No
p Yes p No
p Yes ❑ No
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'):
�URRENTLY WAITING ON SWCD TO OK COSTS HA R E FUNDS TO BEGIN CONSTRUCTION ON NEW LAG
MARKERS TO BE INSTALLED AT THAT TIME.
FACILITY IN GREAT SIiAPE.
TIME: IS RAPIDLY RUNNING OUT FOR GOOD WEATHER DAYS FOR CONSTRUCTION,
3WCD SEEMS TO BE HOLD UP WITH APPROVAL OF FUNDS.
Reviewer/Inspector Name IW. Corey' Basinger-
Reviewerllnspector Signature: Date.

su, «....
❑ Division of Soil alWater Conservation ❑ Other Arc .
`Division of Water Quality
[Zoutine 0 C+nrn1 Taint Q Follom,-u of [)1V ins ectitrn Q follow-u of DSWC review Q Other
Date of Inspection d3
Facility Number �
'Time of lnspection t ■ �.V 124 hr. (lthaurn)
*egistered U Certified 0 applied for Permit 0 Permitted 113 Not () teratirrnal Date Last Operated:
..........................
harm Name: C-�l o�CoE" FarwL5 County: q a .. .......................
......................................r............................... Y' �.......................
OK•ner Name: .......... Ra1.�............................ ...�iLY'.I.��...�..�..� ................................... Phone Na:.....:J�..1�..�..���......: �`�....... .............
Facility Contact: .......... G! i'"................ ............................. T...itle ......................................................... Phone No:.. `'` ` . ..........................
Mailing Address: Ft3 4� LJ t c� k, l L �D C'Z T 0►'' I., �' Z q.�
7{P-............................................................-................................. r............................................... ....
Onsite Represent:hive:......... 1�..................�i �t�.i...... ­....................... ......... ....... Integrator: .................................................................... ..................
Certified Operator: . u�.... ..: ..............0..:!.S[�e�L.......................... . Operator Certification Number ..---.......g...........
I.nenfinn of Fnrm-
!i... w� ........ �' ...[ I Kt ......�:!..... .................kt
......1............................'........I�irl K ...l......:......}................z..............�'...........
.......... °j" .".'.............. ..... ............................................................. .......... .............. ................ ...........................................
Latitude 3S a `3"`� ' '6 Longitude • ©' 'k
Swine
Design Current Design Current
Capacity Population Poultry Capacity Population
❑ Layer
❑ lion -Layer
EEEJ
❑ Weart to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Cattle Capacity Population
PEJ
Dairy
,Von -Dairy
❑ Other
Total Design Capacity
Total SSLW
1 --'i Z0 1
Number of Lagoons 1 Holding Ponds 4 L Subsurface Drains Present J ❑ Lagoon Area JLJ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes Er&o
2. is any discharge observed front any part of the operation? ❑ Yes CTNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RNo
b. II'discharge is observed, did it reach Surface Water'? (II' yes. notify DWQ) ❑ Yes E;�No
c. It'discharge is observed. what is the estimated flow in gal/rain?
d. noes discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes RNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
4. Were there any adverse impacts to the waters of the State other than front a discharge? ❑ Yes 1�No
S. Does any part of the waste nuinagentcitt system (other than lagoortslholding ponds) require ❑ Yes fflNo
maintenance/improvement?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes RNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes R"No
7/25197

. Facility Number:
S. Are there lagoons or storage ponds on site which rteed to be properly closed? ❑ Yes io
Structures La onus ll Idin Ponds Flush Pits etc.)f
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes P No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............�.t.:.......... Z�-7
............................. ...........
Freeboard (ft): 3 / S / , S ' wj3
W. is seepage observed from any of the structures? ❑ Yes XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed:! ❑ Yes 9No
12. Do any of the structures need maintenancelimprovement^ ❑ Yes R'No
(If any of question% 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Applicatiolt
t4. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
S[ mac-er.....
1 . Crop type ........................ ...............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement'?
19. is there a lack of available waste application equipment'?
20. Docs facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permiltl d Facilities Only
23, Does the facility fail to have a copy of the Animal Waste Management flan readily available'!
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.vitilations or deficiencies were noted during this;visit..You;will receive no ftirth�er
coeres'06nde ee t oOt this:visit: .. ;
WYes ❑ No
❑ Yes O'No
❑ Yes kNo
❑ Yes O No
❑ Yes �1 No
❑ Yes OFNo
❑ Yes ONo
❑ Yes No
Cl Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Cotrunents (refer to question ##): Explain any YES answers and/or any recommendations or any other. comments.
Ilse. drawings of'facility to better explain situatiuies, (vise additional pages as necessary}:°'
CI { JL�t• (� W A_A; .u- dl. GuC i ek. (_,osAk -51,� ► .s -D
cl-
�y�}Ga �$c S`� ��•t 5 'ti o t;�e �t l t� wt��-t �,r e.�.? � �-�•�--�- s -
7/25/97
Reviewer/Inspector Name Ca�.r~cc�'
Reviewer/Inspector Signature: � � Date: ,;)3

16 Routine p Lumptau(t p fnuow-up of 1)%VV inspection p
Facility Number
Harm Status: © Registercd p Applied for Permit
p Certified p Permitted
p Not 0perat(ona hate Last Operated:
Fartn Name: Chriscoe Harms
p of (fowl_: review p
Bate of Inspection
Time of Inspection 9:45� 24 hr. (hh:(nm)
ota s ime' m! ractron10 lours
(ec:1.25 for I hr 15 rain)) Spent owRe►'ie►►,
or lnspection�(includes:travel,and.proccssiiig)
County: Hai(dalpxt.......................................... .I.Y.SIio........
Owner Name:Roy............................. .... cllris�cn,t;........ ....... ....... ............. ................. Phone No: .......................................................
FacilitvContact................................................................................Title:............................................................... Phone No:....................................................
Mailing Address: 4 tiZ..I:.[trl:..Crc k.lf7ill.ktci................................. Seagruv.e.N.0 .......................................................... 27a4.1...............
OnsileRepresentative: .................. - ...................... ...................................................... -., Integrator:.......................................................................................
Certified Operator:Ray:.l—.................................... Cltri.scats............... ....... .................... Operator Certification Numher:18301.............................
Location of Farm:
Latitude ■ ©` `� Longitude ®■ ®° ®44
Type of Operation i
--j
SiVine
Design Current Design Current
Capacity Population Poultry Capaci(y Population
❑ Layer
p Non -Layer
❑ can to Feeder
®Fee er to - ut(s t
p arrow to Wean
p arrow to Feeder
❑ Farrow to Finis,
❑ Other
Total Design Capacity
Total SSLW
Design Current
Cattle Capacity Population
7,300
985,5
Nutnher of Lagoons 1 IIoIding Ponds ❑ it }sur ace rains 11resarilo Eagoon Xrea ❑ Spray Rc � rea
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed Cront any part of the operation?
Discharge originated at: p Lagoon ❑ Spray Field p Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, ► hat is the estimated flow in galloon?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse imp.:cts to (lie waters of (lie State other than from a discharge.?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
4/30/97
p Yes ® No
❑ Yes ® No
[]Yes ® No
[]Yes ® No
❑ Yes ® No
p Yes ® No
[]Yes ® No
❑ Yes ® No

acr r y um per: 76_04 40
6. is facility not in compliance with any applic le setback critcria in effect at the time of design? Yes X No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures_(Lagnons and/or Holding Ponds)
9. IS storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes M No
Freeboard (ft): Stricture 1 Structure 2 Strrcture 3 Structure 4 Structure 5 Stricture 6
2 It. (+) 1 ft. (}) 2 ft. 5 ft (�}
10, Is seepage observed from any of the structures? ❑ Yes IN No
11. Is erosion, or any other threats to the integrity of any of the structures observed? p Yes H No
12, Do any of the structures need maintenance/improvement? p Yes H No
(If any of questions 9-12 was answered yes, rind the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or rnaximurn liquid level markers? Byes ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the Stale, notify DWQ)
15. Crop type .... .................. Ecscite.............................. ................... iv—c ...... .................. ....... Cora.(.5ila,ge.&..Graiaj ......... ..... .......... .........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')? ❑ Yes ❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
M No
18.
Does the receiving crop need improvement?
p Yes
M No
19.
is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require fi Follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewerllrispector fail to discuss review/inspection with on -site representative?
p Yes
® No
For Ccrtified Facilities Ong
22,
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
p Yes
p No
23,
Were any additional problems noted width cause noncompliance of the Certified A WMP?
❑ Yes
p No
24.
Does record keeping; need improvement?
p Yes
p No
Comments (refer to,question 4): 1?xl)lain .try Yu;S answers and/or :try recouutieridations i)r• au►• other comments.
Use drawiufs.of,faciIity'to better explain situatious. (Ilse additional pages as necessary]:
'
.,
13 - Waiting on SWCINRCS to set elevations for pumping markers,
16 - No plan yet. Facility should -require very little work to become certified.
22-24 - No plan yet.
ility isJii excellent condition. Oxortator currently not operational but should;be repaired,this week. Facility is very well
ntai:led and operated,
J
Reviewer/Inspector Name 'Corey B, singer
Rev icFverllnspcctnrSig;nattrre: Date: 3-0 l �

....,_
Fe DSWC iel n e o pera inn eview
...:. ..... :
w
ODWQ Animal Feedlot Operation Site Inspection
Routine ❑ Complaint Q Follow-up of MV2 inspection 0 Follow-up of DSWC review Q Other
Facility Number
Date of Inspection
� ❑�
Time of Inspection l4 : o0 24 hr. (hh:mtn)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1,25 for l hr 15 min)) Spent on Review
❑ Certified ❑ Permitted lor Inspection Qucludes travel and processing)
❑ Not Operational Date Last Operated:
Farm name Cq County: ............................. ................... W$R•..
Land Owner Name: �°`7r. S.r!n �Sc aC — Phone No: -9 t�.' ..8�..�...... ��_ 8. ............................
Facility Conctact:........
Title:
Phone No:
,flailing Address 4-Z (. Z Fa V_ �,..M ti-!,,,.. CQw�,r. C ...... -• 41..
- .............. _..... .-. .....r..
Onsite Representative: 'i........ ................. Integrator:..i�.,G,... ?e �y G"fa7_+`1 .�...tnic:......---
Certified Operator: .... ........................L.......................................�................................ Operator Certification `umber:......................
y C44-2i 5 i r i53�
Location of Farm:
rAK-5 ...... &.. ?Lit..... r..A_,a."M...... 4..17:44..BVkk...... t ................ Tw AF.t?ex...... ....... 4
ZZ
r t ►ti i, it v , 3'-° Deg raw d `V - u!.....-1-�.T ......ja!v..0.4.51.16A.................... ..... .0
Latitude ©• ©' l5L6 Longitude ®• ©•4.
t ype of tjperation and t)csrgn Uapacity
•„�
Design," Current `-Design" _ Currcnt Design' Current
Swine Ca ai itv Population Pouitr!' Ca Nacit►' Po Population Cattle Ca aci Pv ulativn
❑ Wean to Feeder I❑ Laver [I Dairy
Weedcr to Finish 130o 73e>0 ll❑ Non -Layer `: ❑ Non-Dairvi
Farrow to Wean
Farrow to Feeder Total Design Capacity, Sao
Farrow to Finish Ijr
�. .......... , To#ai
•••-• Other
,. V-.,---•sue,,,..
l\umhe'r of Lagoons !•:Holding Ponds 4—;. ❑ Subsurface Drains Present
x=3' Lagoon Area spray Field Area
....sr`�,.Isl3i:w��•.�:s'a:...•�;..,..s•:..1:�:, ¢E:r'..e �. .e:i.tt,.i.?���F.s.. :.if �S .K., t.bir?, .F:F '�j:�
,
,
-Cyperal
1. Are there any buffers chat need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'! (If yes, notify DWQ)
c. If discharge is obsmed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
S. Dues any part of the waste management system (other than lagoonslholdinb ponds) require
maintenance/improvement?
4/30/97
❑ Yes �Q No
❑ Yes KNa
❑ Yes R No
❑ Yes ARNo
❑ Yes .9 No
❑ Yes JiitNo
❑ Yes ErNo
❑ Yes, J No
Continued on buck

Facility Numhcr:.A'9:S ........ Q,.
,
6.
Is facility not in compliance with any apples setback criteria in effect at the time of desi.0
❑ Yes
PeNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
XNo
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
XNo
uettt -es (Lagoons a _(Ur l� _ Cnkling Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate? 15i(7�,eC Rix
❑ Yes
fi&No
Freeboard (ft): Stricture 1 Stricture 2 Structure 3 Structure 4 Structure 5
Structure 6
.. de le
.'... - --.... ........ ........
10.
Is seepage observed from any of the structures?
❑ Yes
IM No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
9No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
M'o
(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?
,�j Yes
❑ No
Waste Application
14.
is there physical evidence of over application?
❑ Yes
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
�,KNo
15.
Crop type ...... Gf�S. ......... .!.:�..... ..�.1.............. �... ! ...�i ► ��t � .....:.
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
JKNb
18.
Does the receiving crop need improvement?
❑ Yes
KNo
19.
Is there a lack of available waste application equipment?
❑ Yes
g[No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
JR No
2I.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
07No
For
Cectified-Lagilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
24.
Does record keeping need improvement?
❑ Yes
❑ No
Comments (refer to question ff): Explain any YES answers and/or any recommendations of any other comments. —
Use drawings of facility to better explain situations. (use additional pages as necessary): .
13. Via 1,47sk5 s► -to Ots}AA PtW - W-444r4VS -
4
/44 should u f
22 -- Z 4 - 441 plt;i.n � '•
Revie►►•erAnspector Name
Reviewer/Inspector Signature:
Date: 3a
cc: Division of Water Quality, Water Quality SAction, Farithy Assessment Unit 4/30/97