820606_INSPECTIONS_20171231

NURTH CARULINA
Department of Environmental Qual

type of visit: k.7-Uem nee inspection V uperatton xevtew V structure Evatuatton V reenmcat assistance
Reasonlor Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: I 5 Departure Time: County:
Farm Name. .� Owner Email:
Owner Name:, N,c_ ISo ►lam-��'�S _ Phone:
Mailing Address:
Physical Address:
Region: F—_
Facility Contact: Gy *41 �j. gT_y-(,P kre,�f Title: Phone:
Onsite Representative: I ( Integrator: WC�""TIs-
Certified Operator: ; �l i r1 �,� f t wI Certification Number: Cod q M
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [3 -No- ❑ NA ❑ NE
[:]Yes ❑No D -I TA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current
❑No
Design
Current
Design Current
Swine ,
Capacity 1'op.
Wet Poultry
Capacity
Pop.
Catrie Capacity Fop.
Wean to Finish
B i�A
La er
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Dai Cow
Wean to Feeder
❑ NE
Non -La er
❑ Yes
EJ'No
Dai Calf
Feeder to Finish
t-( if
Dai Heifer
Farrow to Wean
Design
Cnrren#
D Cow
Farrow to Feeder
D . Poul
Ca a -H
P,o P.
Non -Dairy
Farrow to Finish
11-avers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
Turkeys
Other .. "
;"
Turke Poults
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [3 -No- ❑ NA ❑ NE
[:]Yes ❑No D -I TA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑No
L -1 -NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
B i�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E3 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EJ'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: $' - G Date of Ins ection: 11
Waste Collection & Treatment
4 is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E9-Ne--ffj NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑-I~ * ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 �� .7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L J o ❑ NA D 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 Qj>;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 ❑C .leo ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [}tea ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 go ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance a]ternatives that need ❑ Yes E3-Pto ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): t C
13. Soil Type(s): My 1a 1'1� j iG L.��►�t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Quo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Noo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []I -Vo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes lam"" ❑ NA ❑ NE
❑ Yes [2 -NQ ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[,Ko'
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[1_5o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design O Maps ❑ Lease Agreements
❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑'Ko-_
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall Q 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
❑-leo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
E]_No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Faeili Number: &0 Date of Inspection: f Ra`,
19-
❑,Qo '
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E '"U ❑ NA
❑ N£
2%. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ug-Ilo ❑ NA
❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ETo
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
[]Yes
E'Na ❑ NA
[] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Cervo ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
❑,Qo '
❑ 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
[2-<o
❑ 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
ETo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 l . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
u o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q-115
❑ 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
12'5'5
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or°atiy,additional recommendations or an other.eoniments
Use drawings of facility to'better:,eaplsin situations (use additiodalpag es'as necessary).._
,ex v I to -- 3 0 t- 6t 5t
Reviewer/Inspector Name: _ Yj
r
Reviewer/Inspector Signature:
Page 3 of 3
Phone: i 10 - q`3
Date:
2/4/2 I5

k VA-;
Fact'+ lltvis""ton T Water Resources
' � ity'�, Number Z -� () _ - ®Dtseston:oTSaii and Water Conservation
[T7yp; of Visit: EMompliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: -'?] f County: Region
Farm Name: 6,,151 k,��5
Owner Name: kv&--o.. 6o "
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C te-4 t s e3 a.'[�- Title: Phone:
Onsite Representative: Cz-wr' Integrator:
Certified Operator: �'!✓j' Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream ImDacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3'l'o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA [:]NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No 4A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes EfNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ETNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued
Design
C•nrrent
"* D"es_ign
Current
Design Current
INS,
Capacity
Pop.
Wet Poultry Capacity
Pop.
Cattle Capacity Pop.
:�-=
Wean to Finish
La er
Dai Cow
Wean to Feeder
tion -La er
Dai Calf
ED
Feeder to Finish
E{t��7=
Dai Heifer
IFarrow
to Wean
Design
Current
D Cow
Farrow to Feeder
D . PogltCa aei
Pio P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPUIlets
Beef Brood Cow
Turkeys
Othc
ITurkey Poults
Other
Other
Discharges and Stream ImDacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3'l'o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA [:]NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No 4A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes EfNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ETNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: jDate of Ins ection: 7 "lt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D -N ~❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integ=rity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? L9�5 ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 [31"o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 100% 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): - ,&_ 6 e' C 3
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
2<0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E wu
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
C] 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
o
❑ 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.
I
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rainfall inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [;�, No 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes eNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: IDate 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
❑ YesE319-o ❑ NA ❑ NE
Ote appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yeso E] NA E3 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 7�NNo ❑ 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?
I `
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Yes �'No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ Yes E;11�o ❑ NA [j NE
33. Did the Reviewer/] nspector fail to discuss review/inspection with an on-site representative? ❑ Yes C7 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes FE]No ❑ NA ❑ NE
Reviewer/inspector Signature:
Page 3 of 3
Date: �• j�
2141201 S

�E
i'vision of Water Resaurces
- Facility Number - Q Division of Snit and Water Conservation
Q Outer Age, ncyAPM
Type of Visit: Qoompliance inspection 00peratiou Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit: (34o_utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �S ; o(��'' I County: �-
Farm Name: eZt_ f 'U'3 Owner Email:
Owner Name: „ Sri Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: �/()11
6�
Back-up Operator:
Location of Farm:
Latitude:
Region -
Phone:
Integrator:
Certification Number: C 47—,Jo
Certification Number:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
1'op.
Fettle Capacity Pop.
Wean to Finish
I Layer
Dairy Cow
Wean to Feeder
I jNon-Layer_
I
Dairy Calf
Feeder to Finish
jDairy Heifer
Farrow to Wean
Design
Current
IDTY Cow
Farrow to Feeder
D , P,ontt ,
Ca aci
P■o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
40-111911
Turkeys
Other
Turkey Poults
NJ Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
E] Yes � NA ❑ NE
[—]Yes [—]No A ❑NE
E]Yes ❑ No NA ❑ NE
❑ Yes
❑ No
❑ Yes
❑ NE
❑ Yes
ffNo
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 2/412015 Continued

Facility'Number: b Date of Inspection -t-
c
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E34Na_-Fj-NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q -NA!❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes _U2-K-5�
❑ 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
[2'5o
❑ 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
❑Xo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ Io
❑ 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
ECJ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L;kNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q -N" ❑ 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 F1Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): <?k) t-/f� G13
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 and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
p Yes
❑ Yes Ea<
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
L7 No
❑ NA
❑ NE
❑ Yes
is <o
❑ NA
❑ NE
❑ Yes E2 <o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes j ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [DNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacillty Number: - Q Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [17No ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes lJ o'0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a FOA 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? ❑ Yeso /❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2<0' ❑ 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?
[:]Yes 10 ❑ NA ❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [alo ❑ 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 [allo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Ey<o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes [!(No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes O No ❑ NA ❑ NE
omments. re er to question # : Explain an YE answers and/or an additional recommend atioas or any other comments
Use drawings of facility to better explain situations use additional pages as necessary). "
I; .� P ( P g rJ'
'7- 5
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �, J
Date:
2/4/2011

61 Mc
19D
Type of Visit: (9Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Q'Ffoutine Q Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time:1 IiiiDeparture Time: County: Region:
Farm Name: 00(.04",-
Owner
4-t�3
Name:
Mailing Address:
Physical Address:
Facility Contact: cul l - a G _ Title:
Onsite Representative:
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes Q -N'6___0 NA ❑ NE
❑ Yes ❑ No L j. -*A ❑ NE
❑ Yes ❑ No Q�KA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No E51NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes .�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued
'.
'g nt
Desx n Come
Design
Current
Design C►urreut
SwinWeEl! itP
Wt Pltry.pcip�
We to Finish
La cr
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish $¢:
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,anitr
Ca city
Pop.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts Non -La ers
Boars Pullets
w - Twke s
t)ther
Turkey Poults
.
Other Other,"
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes Q -N'6___0 NA ❑ NE
❑ Yes ❑ No L j. -*A ❑ NE
❑ Yes ❑ No Q�KA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No E51NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [] Yes .�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

f
Facili Number: - Date of Inspection:
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EEHdo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): v� i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJNa ❑ 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 Q'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 E] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2-<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes []'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application - �
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes u 'Yu ❑ NA ❑ NE
maintenance or improvement?
11- Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes To ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑IApplication Outside of Approved Area
12. Crop Type(s): 414
13. Soil Type(s): Vy n
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [- ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [41;ro- ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [E" oo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes CJ No [DNA ❑ NE
[:]Yes �o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[D No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
[] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23- If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
Page 2 of 3 2/4/20.11 Continued

t
lFaciRty Number: 0 Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [DN-6_ ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q, io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ld"1"O ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ©'No ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
❑ Yes EWo ❑ NA ❑ NE
❑ Yes [I No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [31�o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative? ❑ Yes [] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes []�No ❑ NA ❑ NE
Comments (refer to question #): Explain y: YES:answers and/or any additional recommendations or -any ather comments. Y
Use drawings of facility to better explain__situations (use additional:pages as necessary).
Reviewer/Inspector Name: \.J L
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `
Date: J Ka
21412014

I
I►MJ /A
Type of Visit: 9Kompliance inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: [Routine Q Complaint Q Follow-up 0 Referral Q Emergency Q Other O Denied Access
Date of Visit: Arrival Timer Departure Time: County;�MLqRegion:
Farm Name: p 5�� t t1 A(.0 Owner Email:
Owner Name: 424,,_41 WlEc`�{O� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Onsite Representative: e/ Integrator: _ V
Certified Operator: 1peGk %A)e5 Certification NumEber47 ('?? 3 E:�%
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current. z Des�gnCurrent Design Current
Swine ,Capacity Pop. Wet PIM) Ca�tac�ity P4 Cattle Capacity Pop.
Wean to Finish Layer Dai Cow
Wean to Feeder Non -La er Dai Calf
Feeder to Finish Dai Heifer
Farrow to Wean Design Current Cow
Farrow to Feeder D . P,onit . Ca ac�t��` .
Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets beef Brood Cow
WS
'`- Turkeys
Other TurkeyPoults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—] NoNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
E]No
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
[—]No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
-VNO
❑ NA
C] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
C—]Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CA
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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
the appropriate box.
❑ Yes
❑ Yes
❑ Yes
Yes X��No
No
❑ Yes [� N
El Yes No
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
❑ NA
❑ NE
❑ NA
❑ NE
Facility Number: - Date of Inspection:
❑ NE
❑ NA
❑ NE
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L2,Ne---D NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No 2'11A--'
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - —3_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®'leo f❑ 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
Ej-N'5—T] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[2 -NV— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3 90 ❑ 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
[3'151-o- ❑ NA
❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CA
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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
the appropriate box.
❑ Yes
❑ Yes
❑ Yes
Yes X��No
No
❑ Yes [� N
El Yes No
❑ NA ❑ NE
❑NA ❑NE
DNA ❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectioWN5
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

0A rf, t 1-g-, A N
F'acili Number:% Date of Ins :41
0 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes @•?do ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I4"0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes D-?ro' NA ❑ NE
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E?Co__ ❑ 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 R3-lgo [INA ❑ 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 1 S , ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Noo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes E]<O ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes &< ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers-and/.or any additional recommendations or any other comments
Usedrawings of facility to better explain situations (use additionalpagesas necessary).
d16 1-(o -1)
3 c.r r S /,1 0
Reviewer/Inspector Name: C[, Phan . I
E] NA ❑NE
❑ NE
Reviewer/Inspector Signature: Q/i/LM Date:'
Page 3 of 3
2/4/2011

i ype oz visit: upK-ompuanee inspection v "peranon meview V atrueture r,vatuatton t_j t ecnnieat Assistance
Reason for Visit: (DIfoutine Q Complaint O Follow-up d Referral O Emergency Q Other 0 Denied Access
Date of Visit:
;m ...I l
"
Arrival Time: `3d A
Departure Time: `pp County: c&W0
Farm Name: r�c�
SI1F
N 'FARMS
Owner Email:
Owner Name:
M?_\Z,0
l U rAF i.S
Phone:
Mailing Address:
Physical Address:
Region: E&
Facility Contact: CUR- cS_s Title: Phone:
Onsite Representative: C§mrc_ Integrator:
Certified Operator: ��EP� l,] ��� Certification Number: g Q,LAIR3 g
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
;m ...I l
"
Design
Current
Design Current
"r�FW_e_a,to
et Poultry
0 NE
acity op
Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish p
F'
Dai Heifer
Farrow to Wean
Design
Current
D Caw
Farrow to Feeder
` D , POultry
Ca aci
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullcts
Beef Brood Cow
Turkeys
t
Other
Turkev Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
[A NA
❑ NE
❑ Yes
❑ No
[f NA
0 NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any pan of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes ["I No
❑ Yes []YNo
Q�NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 .2/4/1011 Continued

[Facility Number: - Ion& jDate of Inspection: y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes © No 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No g"'NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ;:01
Spillway?:
❑ Yes
Cv�No
❑ NA
❑ NE
Designed Freeboard (in): rT l ri
❑ Yes
[�No
❑ NA
❑ NE
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
['No
❑ NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[Z"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
rq'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
[xNo
❑ 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
[EfNo
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[ rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[DNo
[] NA
D NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN [3 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s): i "p"k Z.C~1•0• I OfIRP, k.1hPAAI
AaS
13. Soil Type(s): NofjokV, 6 -,)L 1 Ac r+S 11.3 P'sRe n, CSU Ala&nof\ d -.S — -
14. Do the receiving crops differ from those designated in the CAWMP? D Yes [2"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [SKNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Cv�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
['No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes [1 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[v/NA ❑ NE
Page 2 of 3 21412011 Continued

Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
E] Yes
[D'No
❑ NA
Facili Dumber: ba - Date of Inspection: 1419
1'
24. Did the facility fail to calibrate waste application equipment as required by the permit?
E3 Yes
3No
E] NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
[�fNo
0 NA ❑ NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
Yes
[g No
❑ Non-compliant sludge levels in any lagoon
NE
permit? (i.e., discharge, freeboard problems, over -application)
List structure(s) and date of first survey indicating non-compliance:
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[] Yes
[yNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[-] Yes
[:] No
dNA [:] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
E] Yes
[D'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
(2 No
0 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
[g No
0 NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
[3No
0 NA
0 NE
[) Application Field Q Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
[2/No
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[TNo
❑ NA
NE
34. Does the facility require a follow-up visit by the same agency?
[-] Yes
[SjMo
NA
NE
Comments (refer to question #1): Explain any YES answers and/or_anyadditional: recommendation or:any other comments"
Use drawings of facility to better explain situations (use additional pales as necessary).
_ , Y
,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
Phone: c�10 - 3O16-W6S
Date: S� RQ -1-3-
2,1;12011
3-
2/4/2011

aw's - 4
Type of Visit: orapliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (PWo-utine O Complaint ( Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit:
l 4 ' Arrival Time:
Departure Time: zV
County:
Farm Name:
Swine Capacity Pop.
Owner Email:
Capacity
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region: F
Facility Contact: 0,.LLf` e rzf[ Title: Phone:
Onsite Representative: Integrator: _6
Certified Operator: 4'-eC.S Certification Number: g��
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
r
,Wet?1?oiiltry
Capacity
Pop:
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er,
Dai Calf
Feeder to Finish
r
Dai Heifer
Farrow to Wean
__
� q
Design
Curren
D Cow
Farrow to Feeder
D .rPoultry Ca acitfr
Po .
-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Turkeys
el
Turkey Turke Poults
other
10thcr
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reachcd waters of the State (gallons)?
❑ Yes Ej-iQo ❑ NA ❑ NE
❑ Yes
❑ No
LR<A
❑ NE
❑ Yes
❑ No
M A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No EflIA ❑ NE
❑ Yes Cgo< NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: -ZZKI Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No El -KC ❑ NE
Structure I` Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
%
Identifier: /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[R<o
❑ NA
Spillway?:
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ NA
Designed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[R-Nlo'
❑ NA
Observed Freeboard (in):
acres determination?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
18. is there a lack of properly operating waste application equipment?
❑ Yes
B o
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
03<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
E3<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, andlor wet stacks)
9. Does any park of the waste management system other than the waste structures require
[:]Yes
G?<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
E] Yes
�,,�
L'7 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes t.. o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window u4``❑tt , ! Evidence of
Wind Drift ❑ Application Outside of Approved Areea"
12. Crop Type(s): i 6 &-t)&-t)/ � . Jay 6c-jw-
f�]nn Soil Type(s): K-�_- 1� A, L
13.
❑ Yes
[NJo
%
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[R<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[R-Nlo'
❑ NA
❑ NE
acres determination?
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[g'�io
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
B o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[NJo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ejll o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21 . Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
Q No
❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[-]No
A ❑ NE
Page 2 of 3 2/4/2011 Continued

IFacilfty Number: 3Z - 601,1 jDate of Inspection: & a0z
- 24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes E3/No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [31'<lo ❑ 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 fust survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [3-<A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes lam'`l'o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes Q'1q�o'
❑ 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 [ZJ-X'b
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Ildilo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes B"5o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on-site representative?
❑ Yes [5<o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [91<o
❑ NA [] NE
Comments (refer to question.W)Explain any -YES answers and/or any additional recommendations or any�otl er coi die—ft 1.
Use'drawiii s of facility to better.ei lain s4"fions use additional a es.:as.necessa
Reviewer/Inspector Name:
Reviewer/Inspector S
Page 3 of 3
Phone: Q�
Date: !a Z&
4/2011

RrAfS 2-05-2010
Type of Visit (5- ompliance Inspection U Operation Review (.) Structure Evaluation V Technical Assistance
Reason for Visit &M -u -tine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /-Z 8 -/Z) I Arrival Time: Departure Time: County: Y4'""f S'046 Region: 'r—Wl
Farm Name: Cz n s- 4 e��� Owner Email:
Owner Name: /r le-150AlkAILCYS Phone:
Mailing Address:
Physical Address:
Facility Contact:
Cu k41:5 84Ywr
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Sp Phone No:
Integrator:
Ca tiLG v 1 JL_ t --CIL V &A— S
Operator Certification Number:
Back-up Certification Number:
Latitude: o =1 =" Longitude: = ° u
Design Current
Design Current
Design Current
wtapacity
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Population
❑ Wean to Finish
❑ Layer
❑ NA
❑ Da Cow
to feeder
❑ Non -Layer
❑ Da' Calfeder
Rean
to Finish g20 S
a. Was the conveyance man-made?
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder.
El Yes
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
Gilts
❑Non -La ers
ElBeef Feeder
PE113oars
❑Pullets
ElSeef Brood Co
E] Ngo
El Turkeys
[:1 NE
2. Is there evidence of a past discharge from any part of the operation`?
Other,
❑Other
I ❑ Turkey Po Its
Number of 5truetures:
❑ NE
❑Other
❑ Yes
ETNo
❑ NA
❑ NE
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
LI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
ETNA
L� NA
EINE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
E] Ngo
BA
[:1 NE
2. Is there evidence of a past discharge from any part of the operation`?
El Yes
ET5o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ETNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: SZ
Date of Inspection
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes IJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 3<o ❑ NA ❑ NE
Structural)] StructureD StructureQ3 Structure 4 Structure 5 Structure 6
Identifier: at / L rx Z
Spillway?: tae CJ- CCL
Designed Freeboard (in):
Observed Freeboard (in): -2-2- Z Z Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El"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 IT 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
&<6- ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
LR 1Vo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes
LJ No ❑ NA ❑ NE
maintenance or improvement?
3'-N
Waste Application
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�,�
E3 No ❑ NA ❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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) -�J- LJk4-A f- �o.t/ace..., S � B.zrw...p�e_ (PA3 � 5w.rA11 Gva,'a/ t`O. Y
,��I
13. Soil type(s) No A R Qo, . W xB a;a�
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
io ❑ NA ❑ NE
Reviewerllnspector Name /'i c K"R� V.� S; "v "mak 't 4 s '` Phone: 910• �{ 33.3 300
t.. ..Y'N' i3. s>'k �J-c
Reviewerllnspector Signature: �Q e, Date: r-262-010
12/28/04 Continued
❑ NA
El NE
,ErNo
3No
❑ NA
❑ NE
zoo
[:1NA
ElNE
3'-N
❑ NA
❑ NE
io ❑ NA ❑ NE
Reviewerllnspector Name /'i c K"R� V.� S; "v "mak 't 4 s '` Phone: 910• �{ 33.3 300
t.. ..Y'N' i3. s>'k �J-c
Reviewerllnspector Signature: �Q e, Date: r-262-010
12/28/04 Continued

F
Facility Number: 82 —(vCYa Bate of Inspection /-z -iQ
Required Records & Ducumenls
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EK ❑ NA ❑ NE
the appropirate box_
❑ WtJP ❑Checklists [I Design [:1 Maps El Other
2l.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
i,B"No
❑ 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
R o
❑ NA-
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
M"�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I rJ' No
❑ NA
❑ NE
R'No
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Fi-rNNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAN) certification?
❑ Yes
U✓ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �3<O ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
l� 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
i,B"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
��,��
t±�"No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
,�����
L'3'i�o
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
R'No
❑ NA ❑ NE
Additional Comments and/or Drawings:
12/28104

"BT_V_.,S /o -0s-- zoaq
Type of Visit e'Compliance Inspection 0 Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: -/7—O 9 Arrival Time: f / ` Q Departure Time: 2; Oi County: S' y0X0A/ Region: IRO
FarmName: CNY 5 Owner Email:
Owner Name: r S �s�^� �"fs Phone:
Mailing Address:
Physical Address:
Facility Contact: Cuh,.3 Ro` -Gj L k Title: SSC— Phone No:
Onsite Representative: CUSS 301,11 k_ Integrator:
Certifiied Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 I = ,, Longitude: =0=6
o=6 = «
Design Current
III I Design C►urrent
Design _uff—ent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
to Feeder
❑Non -La er
❑ Dai Calf
Wtean
eder to Finish 160 -LO 7
[9 A
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ NE
❑ Non -Dairy
El Farrow to Finish❑Beef
❑ Layers
Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood CoyA
2. Is there evidence of a past discharge from any part of the operation?
❑ Turkeys
Bilo�
Other
❑ Other
❑ Turkey Poults
❑ Other I
ber of Structures:
❑ Yes
D o
❑ NA
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
❑ Yes
` No
❑ NA
❑ NE
Qischarge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made.?
❑ Yes
❑ No
[9 A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[i'<
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑l No
[�
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Bilo�
El NA
[INE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: 82 —606 Date of Inspection 9-17-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N'o
❑ NA
El NE
a. If yes, is waste level into the structural freeboard?
[I Yes
,T
[1Vo
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I TZ — I ✓�an�v�cf��/e�
Observed Freeboard (in): 3V 3 T 3 J�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
D<o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
0<
❑ 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?
[I Yes
BNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
U leo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
B o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ yes
E}To�_
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0"!sro' ❑ 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 ElEvidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Cov—rj — u3 Le -6,_ f— —Soy joec.nls_ t3 exp... <H�y 5:�..c(/ Gv. w ca.y.
13. Soil type(s) No A W'L I o 3'5o
� -- -
14. Do the receiving crops differ from those designated in the CAWMP? [I Yes t_7 tvo ❑ 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 facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
0"No ❑ NA ❑ NE
CR -'No ❑ NA ❑ NE
3<o El NA 0 N
❑-<o ❑ NA ❑ NE
Comments (refer to gttestion #): Explain any YES answers andlor any recom endations,o any othertcomments.
Use drawingsiof facility to better explain situations_. (use additional pages as necessary}
f r
6004 r-a.k-p
G ocl z�trds
Reviewer/Inspector Name - ¢,v .fi�.r_ i�C C ell e...C.S k Phone: 9�d •x.33. 333 5`
ReviewerAnspector Signature: Date: �% —/7— Z007
12128/04 Continued

Facility Number: Q,2 Date of Inspection M--/7-071
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
❑ Yes
1_7 No
❑ NA
❑ NE
❑ Yes
EINC
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[JNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Yes
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ER<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E[ oo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ko'
[INA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,L-
EKo
❑ 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 L7No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B o
❑ 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
0 rroo
❑ 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
[:1 Yes
�,_�
lwo
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
El<o
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[31qo'--
❑ NA ❑ NE
Additi n 1Cot� dle"ats",aiiil%vf2Dra ings
12128104
12128104

Type of Visit Or -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: X13 _0 $ Arrival Time: /d: 2S~ Departure Time: //. OSq:.. County: -ram+ uj Region- Jf�'RO
Farm Name: 60 S In e ^► i= air a... S Owner Email:
Owner Name: W • Ale.1S0,1Q i:Jcc�-wS Phone:
Mailing Address:
Physical Address:
Facility Contact: 6,,It`s Title: Tc 5Pe-e- Phone No:
Onsite Representative: Integrator: CC (14x11 1_ V-11-1
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ i ❑ « Longitude: = o =I = u
i]
Design` Current
111
Design Current
Design Current
Swine
C►apac! Populah�on
N'ct Poultry
Capae ty�Population
Cattle Capacity Papulation
❑ Wean to Finish
[__1 NE
❑ Layer
[I Yes
airy Cow
❑ Wean to Feeder
❑ NE
❑ Non -Layer
G Igo
❑ NA
airy Calf
Feeder to Finish
-7q 2_
airy Heifer
❑ Farrow to Wean
It
Dry Poury
: °
` r=;
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
©La ers
❑ Beef Stocker
Gilts
❑ N ers
❑ Beef Feeder
HODBoars
Pullets
❑Pulets
❑Beef Brood Cow
.
Ot e
U K.22+°
❑ Turkeys
❑ Turke Pnults
❑ Other
I
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b- Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page I of 3
❑ Yes D'No ❑ NA ❑ NE
❑ Yes
L7 No
❑ NA
❑ NE
❑ Yes
Bl�o_
❑ NA
❑ NE
El NA
[__1 NE
❑ Yes
[I Yes
TN�o
[] � oo
❑ NA
❑ NE
❑ Yes
G Igo
❑ NA
❑ NE
12/28104 Continued

Facility Number: Y2 —10 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
Structure9 StructureV Structure Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -�� 1,4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
LJ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Q No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [I Yes
,,,/
L7 No
[I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Q
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) rAl tom+ ee' rS
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E, N"�o
❑ NA [INE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
L jNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
LO Np
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
E No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
Cotnments refer fo
(_ gitesbon'#) Eaplatn;any�{YES.ansv►ers and/or any recommendations or any other comments.
Use drawings fact
of
IX'
to, etterie'—A un situations (nse addtttonal pages as necessary).:
M Xrce-1 "41 ]�"" r+LC_40 r w
,'OC] CL Pte'
Reviewer/Inspector Name '9
�`� %o ma. ( S ,, ...I Phone: 5/0, V33,333 0
Reviewer/Inspector Signature: .c � Date:
Page 2 of 3 12128/04 Continued

4
Facility Number. tTZ —604, Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g El Maps E:1 Other
❑ Yes 0 5o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E IVo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [lNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [E31 TTo [INA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes Yes ❑ 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 [7Noo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L7 No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non -Compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes B Igo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
AdditiomalComments andlor-Drawings_=
f
Page 3 of 3 12128/04

® Division of Water Quality 0/
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance inspection O Operation Review Q Structure Evaluation E) Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: l07 Arrival Time: //:04 rt,,. Departure Time: //,34 County: [t.4c S" n!
Farm Name: 6-ostit•j Feirnw. Owner Email:
Owner Name: /Vz%SeAI wd+C+�.S Phone:
Mailing Address:
Region: FSO
Physical Address: 7 �
Facility Contact: CLkV-J%.5 t3QVWJf- Title: 'KI'vi �`I�tir• Phone No:
Onsite Representative: Cu rfi :s Su: -w ".- k Integrator: C-0 11 Ck h-ct t'iu.",
Certified Operator -
Back -up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: 0' =' =" Longitude: [�° =+ [�"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder IEJ Non -La et
Feeder to Finish Z D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
i. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current .,
Cattle Capacity Papulattati �=:
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EA No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[N No
❑ NA
❑ NE
I--] NA
El NE
❑Yes
[4No
❑ Yes
® No
❑ NA
❑ NE
El Yes
®No
[:1 NA
ONE
12/28/04 Continued

Facility Number: 82
Waste Collection & Treatment
Date of Inspection I0 -0c? -07
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes [@ No
a. if yes, is waste level into the structural freeboard? ❑ Yes C No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
❑ NA ❑ NE
❑ NA 0 NE
Structure 6
Spillway?;
�M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Designed Fteeboard (in):
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
Observed Freeboard (in):
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
Q Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
CZNo
❑ 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
JI] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ElApplication Outside of Area
12. Crop typc(s) Corw i..iLg.Ji �t�t c; ntS L�.r•u+tidc� , SMa�� G rai w1
13. Soil type(s) No 4Rpt Bba
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
�M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Jk
qW
Reviewerlinspector Name RO'G9 Re.Je Is Phone: 91O.f(33..3300
Reviewer/Inspector Signature: eol ..Oa -- Date: /p -O$` 2D0
11128104 Continued

Facility Number: gZ -•( (p Dante of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ' No ElNA [:1NE
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 [l Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [�j No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(A 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
[M 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 CAWNIP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ YesNo
pa
[:1NA
ElNE
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
I] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[a No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J0 No
❑ NA
❑ NE
Additional Comments and/or
12/28/04

®Divisian of Water F uality
Faciiit� Number $� -- �(p p (a O Division of Soil and Water Conservation
Lit
a Q#her Agency
Type of Visit ® Compliance Inspection 0 Operation Review Q Structure Evaluation C) Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: '/d -D(o Arrival Time: 3:00.1ai DepartureTime: County: .5A��QoV Region:
Farm Name: DS/'t e- Al ,��r h�, l /S Owner Email:
Owner Name: AV UJ�Q 1J _ W 4-�C' `J� _ � Phone:
Mailing Address:
Physical Address: f /
Facility Contact: /Y e -&AJ iL,fr7��2 V19- ; t~. Title: Phone No:
Onsite Representative: Co`D& is L34r.w1e K integrator: 6.;0&AC e_ ___
Certified Operator:
Back-up Operator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: ❑ O E=1' ❑ « Longitude: ❑ o [� g ❑
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑
Layer
❑ Non -La ei
Dry Poultry
Layers
Non -Lavers
Puflets
Turkeys
Turkey Poul
Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: x
M
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
C3 Yes Q�No [I NA El `NE_
❑ Yes
[ No
❑ NA
❑ NE
El Yes No
0 N
0 N
El NA
El NE
El Yes
®No
❑ Yes
,N No
❑ NA
❑ NE
❑ Yes
P No
[INA
❑ NE
11/18104 Continued

Facility Number: It'k— —6 p]o Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [1 Yes fjNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [YNo (INA ❑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
gfNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KTNo
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
D4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
§d 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
[VNo
❑ 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
[1No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
A'dditional:Camtgents`and/v Drn A4' „, Y i, `ip'r� � 969
12/28/04

. t
Facility Number: Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes rR No ❑ NA El NE
Structure I Structurq(9 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): 35 '
M No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[V No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
ER No
6. Are there structures on-site which are not properly addressed and/or managed [--]Yes
k1 No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
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
[g No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes(�
No [:1NA [__1 NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
rO 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?
l l . 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 Drill ❑ Application Outside of Area
12. Crop type(s) CO
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
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
Dyes
ER No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Dd No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q&o
❑ NA
❑ NE
elilatn sttuahons (use add
Reviewer/Inspector Name Phone:�Qlt7lo
Reviewer/Inspector Signature: Date: .S'/D - Z o t2k
12/28/04 Continued

7 -
Type of Visit a Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date
Date of Visit: Arrival Time; .3. 0U j Departure Time: County: Sav+tir�setil Region: ^P_0
Farm Name: _ C a sJ , b:� �o r w►s Owner Email:
Owner Name: / V e 1��N .. Phone:
Mailing Address:
Physical Address: SIL ! 712.3
Facility Contact:
Title:
Onsite Representative: (fL.&ias &CUtilrJe_
Certified Operator:
Back-up Operator:
Phone No:
Integrator: Co L , , e
Operator Certification Number: 183417
Back-up Certification Number:
Location of Farm: Latitude: =0 ❑ 4 ❑ « Longitude: = o ❑ ' ="
Swine
Design . Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
ElWean to Feeder ❑Non -La et
© Feeder to Finish 29> 3 0 o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other --- — - - --�
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. 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 CA No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
EINE
[]Yes
❑ No
❑ Yes
f91 No
❑ NA
❑ NE
❑ Yes
[)] No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: V,2 —G06 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[0 No
❑ NA ❑ NE
a_ If yes, is waste level into the structural Freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / `). dt
Observed Freeboard (in): -347 o2 T a 9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
*1 No
LN
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
00 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
[A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes]
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[4 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) la`. J -I -T ce a.. Aa r.! 5,.-, n 1 i' ra �,:
-•—
13. Soil type(s) A/ar4�. [S a,A6 r�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[YNo
❑ NA EINE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' El Yes
[I No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
M No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (re#er�to gnesbon ##� ExpWin i dy YE$ answers andlorianyerecommendations or any other comments.
Use drawings o#:#acilrty to3b Yter eaplamts[ttiabons: (use add[ti i lrpages as, necessary
:t�-r Y4" � 4��a —k /f_�X.rrr r - k, xd.._a•:7�itn#�+:_
�f G 13 O
s---
Reviewer/Inspector Name Phone: 771q/0 ��� /s"Y/
Reviewer/Inspector Signature: Date: 3 / /s/ 4 -T-
X
s 12/2$/04 Continued

IFacHity Number: Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box, ❑ WUp ❑ Checklists ❑ Design
❑ Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R1 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
[:1 NE
26, Did the facility fail to have an actively certified operator in charge?
❑ Yes
V] No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
❑No
[:INA
[XNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IBJ 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
[19 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by.
❑ Yes
[j No
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
50 No
❑ NA
❑ NE
1!y ' - 4-...�� � � :YY i....�'4'T
`dditional Comments:and/or Drarnngs ,f
121281©4
121281©4

Type of Visit C'1'rompjance Inspection O Operation Review O Lagoon Evaluation
Reason for V[Sit Moutine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number pate or Visit:ff5o Tune: 0-61 D "
FO Not Operational O Below Threshold
ermltted13'�,Ce�ed 13 Conditionally Certified e© Registered Date Last Operated or Above Threshold: - -•� —•
Farm Name: .....1_%°!1 ......IE° ... CQ`rr' `5- County:
Af - Phone No: ...¢ W ... 0 /6
Owner Name: 3f'!.-.�!'iLt`�e'.rS........................._._....».,.. I � S9r�
Mailing Address:..... r. �L(l. .11 lal:....r loi!,ti'Mer!`..
Facilitv Contact: ..... L 1l...JkV tTE;!CS Title: - .-•--._
Onsite Representative: _--- ! � l7f'�+ #[ ! __...._ __ . ....
Certified Operator:............ �++• i c.K
Location of Farm:
M
Phone No:
1.
Integrator:
Operator Certification Number:
E94(wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� ���
Discharges & Stream Imppe
1. Is any discharge observed from any part of the operation? ❑ Yes k o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ Na
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes leo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �i
Waste Collection & Treatment ���
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes Mglo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ------------ ..................... .. ........ ..... —....... ...... ....._.
---- ............
..........................._-----------_ ..........— .............. ----..................................
Freeboard (inches):
12112103 Continued

Faciltty Number: i..' ^ p Date of Inspection .?9 a
p ff
)00 J1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
io
seepage, etc.)
Reviewer/inspector Name 'J W :l+sR_ r
..._. �:.rVM
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 the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
04F6__
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
L7No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
0if0
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
GN6__�'
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop i
hype VVW 11 to
13. Do the receiving crops differ with those designa in the Certifi Animal Waste Management Plan (CAWMP)?
❑ Yes
[}filo'
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
C Pilo✓
b) Does the facility need a wettable acre determination?
❑ Yes
0410
c) This facility is pended for a wettable acre determination?
❑ Yes
[Rt
15. Does the receiving crop need improvement?
❑ Yes
[;N(r'
I6. Is there a lack of adequate waste application equipment?
❑ Yes
❑N rl
Odor Issues
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?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes 10
❑ Yes 0'No
❑ Yes MNe--­-
❑ Yes
:Copaune�ats �i#er to queshgn} F.�cplam anyYES answers earl/or any irecommendatYansoraay o commea�
-Use dr wu f facility to b tier rxptarnktl pages aM necessaiy_} geld Copy Final Notes -
_�_ - :a......_ -
p ff
)00 J1
NQ Ccv,0 .-5
Reviewer/inspector Name 'J W :l+sR_ r
..._. �:.rVM
ReviewerAWspector Signature- Date: a3 9.2 Lo
12112103 r L-11-1 Continued

Facility Number: Ad _ 4 V61 Date of .Inspection o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes L�i'Ro
❑ Yes Q
❑ Yes
❑ Yes
❑ Yes ❑.ado
❑ Yes [Wow
❑ Yes 1NQ
❑ Yes O -W
❑ Yes [ Fo
❑ Yes
0-N-6—
❑ Yes
0,1
O�Ye-­s
❑ No
❑mss
❑ No
❑ Yes
M.Pfe
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
ddlttOIIal COn]7nCt7LS a1lC1�Qr=DraVlrtngS -�
o;3T".
rr
+�`�tio n +o `.v'►�i tM C k; (1-41ah � Sri,. �S r- S tc s �r ak,� rr d
ev yf rW.C$ urttx' Alt[ `tvw. k'R �i�►,� a� �•aSpCc i, .
12112103

Site Requires Immediate Attention: NA
Facility No.
1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _T zo 1995
Time: 1 t'. 7.5
Farm Name/Owner: G 4 A eh IFo.* C%n s 1 N lsor. LA_)ck'{'c-{s _
Mailing Address: , 1 �� -Co �,,,,,, �r : t 1, ,,tom N L '2A 2 3 �
County: 5;�.... s
Integrator:, C0�ol lr s Q - Phone: sqz ' O los
On Site Representative: _ N *_ Phone:. _ 5 Q, -- l t
Physical Address/Location :G 6 s �« c� . +� . +,Sp, ►-t 3 t
Type of Operation: Swine X Poultry Cattle
Design Capacity: Z`� `+ o Number of Animals on Site: ZR 4 O
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: fd Ft. Inches
Was any seepage observed from the 1 n(s)? Yes or(N Was any erosion observed? Yes or(F)
Is adequate land available for spray? Yesr No Is the cover crop adequate? Yes o No „oY az -N%L5 -r,. *
Crop(s) being utilized: Coal �k <
Does the facility meet SCS minimum setback cnteria? 200 Feet from Dwellin s? a or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ore
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: - y
Ll WiEw R t>�5L.wGooa To tsE cr,�T,F•�� T v�-►a fou+-•.��
`�.aad,i Ta iC�t`-S�s�i�L� L.�c� C.ea►yt�..\ S r• c yk kA,. A.
i c.4u, �i L.! • c, k W
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

]1N31ML VMSTE )#LIMN PX" CSRTIPICATIDM DOA 303$P OR KZPAIMED P =LDTS
Please return the c=mpleted form to the Division of wire^=^ tal Management at
the address on the reverse ■ida of this fora_ ,
Name of
Address:
Phone No. 4/6,
County:— 5< -.0s,
Farm location: Latitude and Longitude:l$° L' 3.7/=�= _e_: Q ' (required) . Also,
please attach a copy of a county road map with location identified.
Type of operation (swine, layer, dairy, etc,); 5....re
Design capacity (number of animals). _ ti2I
Average size of operation (12 month population avg.), en _ -
Average acreage needed for land application of waste (acres):
i�arsasszs=zizarzz:zsmza3�asssizaiizzszsssszzasruts:r.z�s7zisazirassszzzasossssaa
Tech=lCal Specialist Cestificati=
As a technical specialist designated by the North Carolina Soil and Water
Conservation Co=ission pursuant to 15A NCAC 6F .0005, I certify that the new or
expanded animal waste management system as installed for the farm named above
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to 15A NCAC 211.0217 and
15A NCAC 6F .0001-.0405. The following e*lements and their corresponding minimum
criteria•ha�been verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party) ; access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwater runoff events less severe than the 25 -year, 24-hour
storm.
Name of Technical specialist (Please Print) ,kr �� S LS f5o
Affiliation:
Address (Agency) : ? o g- 1-6 0 Phone No. li�/'
Signature: _ .rte �_� _. Date:
C1w,1ar/23aLiQOr 1lgreaz�aat
I (we) understand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures. I (we) know that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25 -year, 24-hour storm- The
approved plan. will be filed at the farm and at the office of the local Soil and
Water Conservation District.
blame of Land owner n (Please ming)
Signature
Date: j -.5--_ f
Naaxa of ]aaagar, if different from owner (Please print);
Signature- Date -
Note: A chazige in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 6o days of a title transfer.
DEM USE ONLY : AGrEW#1
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