090069_INSPECTIONS_20171231

(Z 114 s �a bE (- 17 6C3
Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
.Facility Number: 090069 Facility Status: Active Permit AWS090069
Inpsecdon Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Bladen Region:
Date of Visit: 10126/2017 EntryTime: 11:00 am Exit Time: 11:45 am Incident a
Farm Name: Squirrel Hip Farm .owner Email:.
Owner. Raymond C Marlowe II Phone:
Mailing Address: PO Box 211 White Oak NC 28399
Physical Address: 721 Squirrel Hill Ln White Oak NC 28399
Facility Status: 0 Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
❑ Denied Access
Fayetteville
910-876-2899
Location of Farm: Latitude: 34° 44'23" Longitude: 78° 43' 06"
Take Hwy. 53 towards White Oak. At White Oak tum Lt. on SR 1318 (River Rd.) and go approx. 0.25 mile, power sub station on the
right and Hancock Farm on the left_
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, $ Treat Waste Application
Records and Documents Other Issues
Certified Operator. Barry D Billups Operator Certification Number: 17943
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Kathy Barker Phone
On-site representative Kathy Barker Phone
Primary Inspector.
Inspector Signature:
Secondary Irmpector(s):
Bill Dunlap
Inspection Summary:
Calibration Sept 15 Sludge Survey 12-18-2017 0-2.9, P-2.8 42%
Phone:
Rate:
page: 1

Permit: AWS090069 Owner- Facility : Raymond C Marlowe It Facility Number: 090069
Inspecban date: 10/26/17 Inpsection Type: Compliance Inspection Reason for Visit Routine
Regulated Operations Design Capacity Current promotions
Swine
M Swine - Wean to Feeder 2,600 1,600
Total Design Capacity: 2,600
Total SSLW: 78,000
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 09-69-1 19.00 24.00
page: 2

Permit: AWS090069 Owner - Facility : Raymond C Marlowe II Facility Number: 090069
Inspection Date: 10/26/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
❑ ❑ ❑
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
❑
Excessive Ponding?
❑
Structure
❑
M ❑
❑
Application Field
❑
PAN?
❑
Other
❑
❑
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
❑
M ❑
❑
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation? -
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
E ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
rtes
No Na No
❑ ❑ ❑
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
Excessive Ponding?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
❑
PAN?
❑
6. Are there structures onsite that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
❑
Outside of acceptable crop window?
❑
7. Do any of the structures need maintenance or improvement?
❑
■ ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yea No Na No
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090069 Owner - Facility: Raymond C Marlowe li Facility Number: 090069
Inspection Date: 10/26/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Applicatlon Yes No Na He
Crop Type 1 Coastal Bermuda crass
(Hay, Pasture)
Crop Type 2 Coastal Bermuda Grass w/
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type S
Crop Type 6
Soil Type 1 Autryville
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
M ❑
Cl
Management Plan(CAWMP)?
❑ M ❑ ❑
If yes, check the appropriate box below.
❑
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
❑
Other?
❑
17. Does the facility lack adequate acreage for land application?
❑
ME]
❑
18. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
Yea No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ 0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ M ❑ ❑
If yes, check the appropriate box below.
❑
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

Permit: AWS090069 Owner- Facility : Raymond C Marlowe II Facility Number. 090069
Inspection Date: 10/26/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Document8
Yes
No Na No
26. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Stocking?
❑
❑
and report mortality rates that exceed normal rates?
Crop yields?
❑
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
120 Minute inspections?
❑
❑
contact a regional Air Quality representative immediately.
Monthly and 1" Rainfall Inspections
❑
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
Sludge Survey
❑
❑
(i.e., discharge, freeboard problems, over -application)
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the Facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
Application Field
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑
❑
25. Is the facility out of complianoe with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
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?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
N ❑
❑
Other Issues
Yes No Ha No
26. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ N ❑ ❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ N ❑ ❑
page: 5

Type of Visit: Qr'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: "outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:Wry Region: l ieo
Farm Name.,�(�
❑ Yes
F`t!/�'1
Owner Email:
❑ NE
Design Current
Owner Name:
-Design
Current
Phone:
Swine C'. Pop.
Wet Poultry
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: A q- S
Certified Operator: t fI d`y Ktj 1" t Certification Number: t 7 I U
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
{1c,c �. 'Z cs bl24 iVotJ zo(6—PC-- O(U
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[gNo
❑ NA
❑ NE
Design Current
-Design
Current
Design Current
Swine C'. Pop.
Wet Poultry
- C pacify
Pop..
@attle Capacity Pap.
Wean to Finish
❑ Yes
1-a er
[3"I -A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Dai Cow
Wean to Feeder
Non -Layer
I
❑ Yes
❑ No
Calf
Feeder to Finish
2. Is there evidence of a past discharge from any part of the operation?
T
Dai Heifer
Farrow to Wean
❑ NE
Design
Current
Cow
Farrow to Feeder
D , Poult .
,£ Ca aci
P,o p:'
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I 113cef Brood Cow
Turkeys
Iff Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[gNo
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Ea -N -A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[3"I -A
❑ 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
E: j4A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[J" o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes C3 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Eacili Number: - Date of Ins ection:
❑ Yes
UR No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
Q.No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[jP?
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
EJ No
Identifier:
❑ NE
the appropriate box.
Spillway?:
❑WUP ❑Checklists ❑ Design p Maps ❑ Lease Agreements
❑Other:
Designed Freeboard (in):
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3110
Observed Freeboard (in):
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E>o
❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
E!rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[ 'i o
❑ NA
❑ NE
waste management or closure plan?
2/4/2014 Continued
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
r;jNo
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[3'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
[]'TVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E]-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P?rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Typc(s): aGl'�R 'fi-'o
I _
13. Soil Type(s): (J L i e
14. Do the receiving crops differ from those designated in the CAWMP? [::]Yes [:],3Vo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [??No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes E?J►3Q'o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
UR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q.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
EJ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design p Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3110
❑ 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
E!rNo
❑ 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
2/4/2014 Continued

Facility Number: -C jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3 -Ko ❑ 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 E3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L ''No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [lqo ❑ 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 ElNo ❑ 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 [DIo ❑ 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 Q110 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [jio ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 04 -to ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2 -No ❑ NA ❑ NE
Comments (refer to;question.#): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary). m
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3M
Phone:d 12
139- 3 V �( -
Date: P n644 IL
1/4/20 1

Q ( k -P
CtQe4.�-
Type of Visit: _U'Com ance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visi#: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j,%� Arrival Time: j i b Departure Time: County: Made-, Region: rt4D
Farm Name_ �s�;� ! r`�f /ViIrR Owner Email:
Owner Name: (,✓ 't Phone:
Mailing Address:
Physical Address:
Facility Contact: iGu-((e-rl' Title: Phone:
Onsite Representative: r /{ Integrator:
40
Certified Operator: p./y c 1 `� ,/�l 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?
❑ Yes
[D'K_o_
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
❑ Yes
Wean to Feeder 6
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Non -La er
D . P,oultr
Design Current
Ca aci P■o
Da' Calf
Da' Heifer
Cow
Non -Dairy
❑ Yes
Farrow to Finish
11-avers.
❑ NE
C. What is the estimated volume that reached waters of the State (gallons)?
Beef Stocker
Gilts
Non -Layers
❑ Yes
❑ No
Beef Feeder
❑ NE
Boars
❑ Yes
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
❑ Yes
©-ITo—
[] NA
❑ NE
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[D'K_o_
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a Was the conveyance man-made?
❑ Yes
❑ No
❑TIA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[3 -ITA
❑ 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
❑-A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
QIXo
[] NA
ONE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
©-ITo—
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2014 Continued

71 2w
acili Number: -.42 1Date of Inspection-
Waste
ns ection:Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes S-Na—E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q..NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 00-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EgWu- ❑ 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
❑"1 0�
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
Ido
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q -t ro
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yesr'10
r
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ r5 o
❑ NA
❑ NE
maintenance or improvement?
❑-#o
❑ NA
❑ NE
Required Records & Documents
Waste Application
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[aflo
❑ NA
❑ NE
maintenance or improvement?
�o
❑ NA
❑ NE
the appropriate box_
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground p 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): .9 CJ S S 6 0
13. Soil Type(s): V
14. Do the receiving crops differ om those designated in the CAWMP?
❑ Yes
Ido
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3-'qo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Da No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
plgo_
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑-#o
❑ 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
�o
❑ NA
❑ NE
the appropriate box_
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements E] Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes �o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [TNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

facility ;Number: - Date of Ins ection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g5No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes !J " o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [! No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �io
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes dNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [frNo ❑ NA ❑ NE
Comments (refer..to question. #)r Expiain : ny YES-answers:and/or any additional recommendations or any other comments::= -
Use drawings of facility to better expslim stuations tise-a¢ditional pages as necessar3)...
4 ruts p -X,6
5cof mac(
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes []'No ❑ NA ❑ NE
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes [3�&o ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
Reviewer/Inspector Name: L
Reviewer/]nspector Signature:
Page 3 of 3
C Phone: L(�_ 3 :J 3 J r
Date: c.] nyr_ t
2/4/2014

` � I hil s I t ►��v �
Type of Visit: ('Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0�koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; od Departure Time: �� County: Region:^
Farm Name: sQ a l -t 4(9.11 9.1 r �u Owner Email:
Owner Name: (.*C� Phone:
Mailing Address:
Physical Address:
Facility Contact: _ k 13 Title: - Phone;
Onsite Representative: rIL A
- Integrator: 1''"�-f
Certified Operator: �4 fa 19 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
Design Current
Design
Current
Design Current
❑ NA
Swine,
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity P.
a- Was the conveyance man-made?
Wean to Finish
❑ No
Layer
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Dai Cow
❑ No
Wean to Feeder
Ne
Non -La er
Da' Calf
Feeder to Finish
❑ Yes
❑ No
ElrNA
❑ NE
D ' Heifer
❑ Yes
Farrow to Wean
❑ NA
❑ NE
Design
Current
DryCow
❑ NA
❑ NE
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non -D
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other.
Turkey Poults
NIXON
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
❑ No
Ef NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
F7 rNA
❑ 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
ElrNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,<q
t;IN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2014 Continued

ip
Facility Number: - Date of Inspection: 0 94y
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 ER<A ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T i
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e_, large trees, severe erosion, seepage, etc.)
❑ Yes []-moo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes El 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 t reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F " ❑ 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 YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E2,Ko [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes io ❑ 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): `'-'cpjy jp rp�xskw _C#1 u1'Vµ4,_ kee.'�
13. Soil Type(s)-
J,
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?
Reauired Records & Documents
❑ Yes R2<0 ❑ NA ❑ NE
[:]Yes E 1V o ❑ NA ❑ NE
❑Yes DNo ❑NA ONE
❑ YesLJ 1V ❑ NA ❑ NE
El Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M'K
❑ 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
[Z] -No
❑ NA ❑ NE
F-1 Waste Application ❑Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E],No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

r
Facili Number: jDateof inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [f No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ff"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ,[j?90 ❑ NA ❑ NE
❑ Yes E j No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [?No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q'No ❑ NA ❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [3"No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ONo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature.
Page 3 of 3
U3 -313
r 0 No.) N
214/1014

7
Q1Y'IS
type ur visit.. +V -c ompnance inspection v uperanon xevrew V structure r vaivanon V t cennic31 Assistance
Reason for Visit: (D-1toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: y Wv-, Owner Email:
Owner Name: Nall V44_ p.-.YQ G bA 04— 6W-4? Phone:
Mailing Address:
Region: E -D
Ij
Physical Address: y _ , 7 �^
Facility Contact: Title: ` Phone:
Onsite Representative: v� Integrator: W
Certified Operator: Fjry�,rt/
3 II
Certification Number:
(7I L(I
❑ Yes
Back-up Operator:
Certification Number:
III
Location of Farm:
Latitude:
Longitude:
Discharges and 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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 10 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
sOFF
I. -II
Q ­.Ko
❑ Yes
0-1�0
Designi Mon e
III
Design
Current
=:' Design Current
Swine
Capacity Pop. ..
Wet Poultry
Capacity
Pop.
_ Caftle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
00
Non -Layer
Dairy Calf
Feeder to Finish'{
Dairy Heifer
Farrow to Wean
!Design
Current
Dry Cow
Farrow to Feeder
`D : P,ou!
Ca aci
Po .
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and 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?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 10 ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
0 Yes
Q ­.Ko
❑ Yes
0-1�0
Ej,NA ❑ NE
Q,KA ❑ NE
❑/ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facilitv Number: OT /'Y Date of lnsoection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0-N-6 ❑ NA ❑ NE
[ ],<o ❑ NA ❑ NE
Structure 6
❑ Yes [&No ❑ NA ❑ NE
❑ Yes Eq< ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? r] Yes ga Flo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [, o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ 3' o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []! No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M'�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 ❑ Application Outside of Approved Area
12. Crop Type(s): Sey SG O
13. Soil Type(s): _ "V'4'A4' ilty 40
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[LKo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E3,Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q),No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Po
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ft[�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�hfo
❑ NA
[:]NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Z]ANo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
0 Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
02-14o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Po
❑ NA
❑ NE
Page 2 of 3
2/4/2011 Continued

.f ti
]Facility Number: - Date of Ins ection:
❑ Yes
Qie
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes
�No
[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EBI�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Yes
[Z -No
❑ Non-compliant sludge levels in any lagoon
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.
❑ Yes
[D>o
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[f No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E�Xo
[] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Qie
❑ 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
jbia
❑ 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
[Z -No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[D>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
MlNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
r7l�IVo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q'o
❑ NA ❑ NE
Comments (refer to question #i): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C
Reviewer/lnspector Name:
Pau
Dec
Phone} V' - 1..4_
Reviewer/Inspector Signature:M )
Date: X10(, �5 �A'*
Page 3 of 3 214/2011

Date of Visit: Arrival Time:t'7l� Departure Time: //! OM County: ZLP=.�- Region:
Farm Name.-sam ; rr-1_Z__ Fall .-I Owner Email:
Owner Name: r�/i?ne� G �p/ 14cu _ Phone:
Mailing Address:
Physical Address.
Facility Contact: ACor-7A, V W,/ Title: %Y
Onsite Representative: 5 --
Certified Operator: �I f
Back-up Operator:
Location of Farm:
Latitude:
.cf _ Phone:
Integrator: v/ Ow/�_,
Certification Number:
Certification Number:
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)?
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?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
Design Curreat
❑ NA
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
D
La Non-er
I
alf
Feeder to Finish
'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Q._yjP7d'1fFqyWGa
aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
HOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑No
❑ NA
❑ NE
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 n No
[:)Yes 10 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

Facility Number: - Date of Inspection: 7-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E3No ❑ 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 F&] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
IQ No
❑ NA
[D 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
EK1Vo
❑ 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
[5f -No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
;!]-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®-No
❑ NA
❑ NE
33. Did the Reviewer/Impector fail to discuss review/inspection with an on-site representative?
❑ Yes
MNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Wo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or,any:other comments: ` ;
Use drawings of faciHty,to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -T7 (7 = -noa
Date:i�-
214/2011

Facility Number: - Date of Inspection:
KEI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): +f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
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
Callo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®_No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[S -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[K No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes RNo [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
Renuired Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design D Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E 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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes EJNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

I
Type of Visit: UCompliance Inspection U Operation Review U Structure Evaluation t) Technical Assistance
Reason for Visit: (E Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ; pD County: ejlo�jL", Region:t'7
Farm Name: , f 2 tz r'r 3;-- e W%. ' Owner Email:
Owner Name: a,�yM 0 _a- IK Orr Inwe- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: / f i ��. Phone: Q -
Onsite Representative: ���_ Integrator: 171Llrld �iY p� •fes
Certified Operator: 45ar r y I j Lu 5 Certification Number:
T
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop Wet Poaltry Capacity 0 - 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 MDesiCirrent D Cow
arrow to Feeder D a P,oultry Eo Non -Dai
Farrow to Finish La ers Beef Stocker
� Gilts FF Non-La�er Beef Feeder
Boars Pullets XBeef Brood Cow
Turke s
ther` _ TurkeyPoints �
ther Other
jEFI!c:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CR No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑No
[-]Yes allo
[:]Yes [SNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
❑ Yes
oNo
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
(7�.No
❑ NA
❑ NE
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in): 1 g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
EZ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0,No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes 5�-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): L'&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZLNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
oNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(7�.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 CAW -MP readily available? If yes, check
❑ Yes
2LNo
❑ 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 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes EINo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ONo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 214/2011 Continued

)E'acili Number: - Ds ection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;S�No
25, Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes KNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [ ] Yes R No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
V3 No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
� No
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
ENo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
[❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
R No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
R' No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
JtNA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: 2 / D= q,33 33_;av
Date: /
21412011

617
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ollioLine O Complaint 0 Fallow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I 11 Q / Arrival Time: % y Departure Time: County: a�E'� Region:
Faun Name: t.c t C'�GI i _ Owner Email:
Owner Name: C, �I��� �-t3.t 5ttlt�hone:
c
Mailing Address:
Physical Address:
Facility Contact: ��� Title:
Onsite Representative: t -
Certified Operator:
Back-up Operator:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ='
= Longitude: =0=4
o=4 =
gi
Design •urrent
Swine Capacity Population
❑ Wean to Finish
Design Current
Wet Poultry Capacity Population
❑ Layer I I
Design Current
Gattie Capacity Population
❑ Dairy Cow
❑ NE
® Wean to Feeder
❑ Non -Layer I I
❑ Dairy Calf
❑ NE
❑ Feeder to Finish
❑ Daia Heifer
[--]Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
E3"No
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑Turkes
Other
❑ Other
❑ Turkey Poults
❑ Other I
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
L{d<A
❑ NE
❑ Yes
❑ No
2 NA
❑ NE
LANA
❑ NE
❑ Yes
❑ No
❑ Yes
E3"No
❑ NA
❑ NE
❑ Yes UK ❑ NA ❑ NE
Pine I (if3 12/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 214o ❑ NA [INE
a. If yes, is waste level into the structural freeboard? ❑ Yes ElNo E,, <A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
❑ NE
Spillway?:
Designed Freeboard (in):
ElYes
2 No ElNA
Observed Freeboard (in):
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
12No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
U<o
❑ NA ❑ NE
through a waste management or closure plan?
18. Is there a lack of properly operating waste application equipment?
❑ 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
[ <o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E2<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 El Yes
,.,
!S 4
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
WX0
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RrNNo❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
2 No ElNA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
11d No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[!(N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J ❑ NA
❑ NE
T
Reviewer/Inspector Nam ' r M.15-1010 `Phone ! p d J �c3
Reviewer/Inspector Si r Date:
Page 2 of 3 124A104 Continued

Facility Number: L)�L= 4L21 Date of Inspection
Required Records & Documents ,�/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:1 Yes L'7 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B No
❑ NA
EINE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
MNo
[:INA
[__1NE
31.
Did the facility fail to notify the regional office of emergency situations as required by
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[I Yes
,2,N"o
L�{�fNo
I --]NA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[I Ngo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E3 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 04o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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
dNo
❑ 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
B 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
KNo
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
*E No
❑ NA
❑ NE
Additional and
Comments /or Drawings
Page 3 of 3 12/28/04

RL/-Z(S 7-0 -,?o04
*_vision of Water Quality
Eadfity'Number q t'p 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit G),C&mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ��.� Q Departure Time: /� �ZO County: �"l¢d`''� Region•
Farm Name:_52 ;r ✓'e- /�'il Alt Owner Email:
Owner Name: n ,2wjRniJr4 /G1p&j Z- Phone:
Mailing Address:
Physical Address:
Facility Contact: �2u Ai"/AW e- Title: VwNe-V Phone No:
Onsite Representative: l AAW �tc9Cn/ C��.yi� / Integrator: Alum til., BPz'&.14J
Certified Operator: µ✓ S.'//u�QS Operator Certification Number: Ak;4 /7ft3
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = =c = Longitude: ❑ ° =I 0 u
Design Current_ Design Current Design ..Curreat ° 1
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder Z600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf c
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder j-
❑ Beef Brood Co
Number of Structures: �I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
Er NA
❑ NE
❑ Yes
❑ No
30rNA
❑ NE
LINA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
El NE
❑ Yes
[1[�30No
E=No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: � — fo
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes EIIN' o
❑ Yes lr No
❑ NA ❑ NE
El NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LZe d /
Spillway?: ;6ir0
Designed Freeboard (in): f l
Observed Freeboard (in): 244 /
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 ❑ Yes 3<o ❑ 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 QNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Mo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D o ❑ 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 El
E Evidence of Wind Drifl ❑/ ApplicationOutside of Area
�
12. Crop type(s) �ci'Mu d c.� � r,e— J '(;- !! C�► ,`�J_L t7,_ .�
13. Soil type(s) /Iu
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
[3 o ❑ NA
Q l io ❑ NA
L'No ❑ NA
,L—",f N NNo El NA
L�'o ❑ NA
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):
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name . f Pve Phone: 9. V_V' 3333
Reviewer/Inspector Signature: Date:
12/28/04 Continued

i
Facility Number: O C1 — (o -7 1 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 appropiate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes O No ❑ NA ❑ NE
❑ Yes Er5o ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or
❑ Yes
E] No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
e No
❑ NA
❑ NE
❑ Yes
❑-56'
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
ET<o
❑ NA
❑ NE
❑Yes LffNoo El NA C1 NE
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes 21�o_ ❑ NA ❑ NE
❑ Yes M_o ❑ NA ❑ NE
❑ Yes
[ lvo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28/04

Type of Visit compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 040utine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �,�� Departure Time: County:
Farm Name: -54 g] r -A ILE, fl _ For r"d r Owner Email:
Owner Name: lKwx and C ///fir �rr� f��/7S !rte l�li;�i1� � Phone:
Mailing Address:
Physical Address:
Facility Contact: '&"o T_! C Title: Phone No:
Onsite Representative::Integrator: /
j!L* C/
Certified Operator: L22 -1 � � _ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Region: FK D
Location of Farm: Latitude: 0 e [=' 0 Longitude: =° =' = u
loom
Swine
PWean to Finish
75_ic
Design Current Design Current
Capacity Populatpn WetFouitry Capacity Population
❑ Layer
Design Current
Cattle Capacity Population
❑Dai Cow
❑ NA
Wean to Feeder
Ofl
❑ Non -Layer
❑Dai Calf
El Feeder to Finish
❑ Yes
Dairy Heifer
❑ Farrow to Wean
Drypoultry
❑ Da Cow
❑ Farrow to Feeder
❑ No
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
ilts ❑ Non -Layers
❑ Pullets
❑Beef Feeder
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Beef Brood Co3
PBoars
❑ Turke s❑Turke
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Poultsher ❑Other
Number Structures:
❑ NA
❑ NE
of.
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — 9 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3No ❑ NA EINE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in)--
Observed
in):Observed Freeboard (in): Log
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes E4No ❑ 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? 0Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 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
9No
❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
No
❑ NA EINE
maintenance/improvement'?
11. Is there evidence of incorrect application? I f yes, check the appropriate box below.
❑ Yes
%No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
!Crop
12. Crop type(s)r"l
13. Soil type(s) A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
33 No
❑ NA ❑ NE
15. Docs the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
10 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 (refer to question,# . Explain any YES, -answers and/or ani'recommendations or.any other comments. ,
Use driawengs of facility to better eacplain situations (use additional paces as necessary);
Reviewer/Inspector]Name � le(� R�'C`4� •-.� � � Phone: ala-y33�33b�
Reviewer/Inspector Signature: Date:
Page z oj s LL/L6/v4 uununueu

1 Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [SrNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists❑ Design ❑ maps ps ❑ 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No [:INA ❑ 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
CZNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
[INA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
12 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RrNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
[RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[R 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
Y,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
(9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JR No
❑ NA
❑ NE
Additional Comments and/or Drarrmgs <
-.�, � ._ : r: . , . mot'
Page 3 of 3 12128/04
Page 3 of 3 12128/04

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen N. Sullins Director
Division of Water Quality
November 19, 2007
Raymond C. Marlowe
Squirrel Hill Farm
89 Sandy Ridge Rd
Elizabethtown, NC 28337
Subject: Sludge Survey Testing Dates
Certificate of Coverage No. AWS090069
Squirrel Hill Farm
Animal Waste Management System
Bladen County
Dear Raymond C. Marlowe:
The Division of Water Quality (Division) received your sludge survey information on November
15, 2007. With the survey results, Kathy Dugan requested an extension of the sludge survey
requirement for the lagoon at the Squirrel Hill Farm facility not to be required until 2009: Due to
the amounts of treatment volume available, the Division agrees that a sludge survey is not
needed until 2009. The results of the 2009 sludge survey are to be submitted by March 1, 2010.
Thank you for your attention to this matter. If you have any questions, please call me at (919)
715-6937.
Sincerely,
744A?-�
Miressa D. Garoma
Soil Scientist
cc: Fayetteville Regional Office, Aquifer Protection Section
Kathy Dugan
Central Files
Aquifer Protection Section 1636 Mail Service Center
Internet: w%w.acwaterqualitv.org Location: 2728 Capital Boulevard
An Equal opportunitylAffinnative Action Employer- 50% Recycledl10% Post Consumer Paper
fl�o�, Carolina
Alitura!!Y
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

Mivision of Water Quality _-_L10 ' ',_—
=Fadfityumber 0 Division of Soil and Water Conservation 4>/UZ,
0 Other Agency 1 G— -cl`"n%
Type of Visit dzlompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l—a Arrival Time: a t% Departure Time: Da County:
Farm Name: ra I gni Owner Email:
Owner Name: Phone: _
Mailing Address:
Phvsical Address:
Facility Contact: Title: Phone No:
Onsite Representative: j Integrator:
Certified Operator: / �2L.�1� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine -
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region: JE)_;_;;, d
Latitude: =0 =1 0« Longitude: =°= 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
EINon-Layet
Layer I Is
� I � 7090 I.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Currents
Cattle Capacity Population #
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �I
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 W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C�No
❑ NA
❑ NE
❑ Yes
12�No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: - Date of Inspection —i7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes SNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes IZ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes � No El NA [:]NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CANo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5a No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EK 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) Jbfrrhjde H2k4 - - /_D_✓_= 5Z!?4j-
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
t4 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
fR No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P[No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
V.No
❑ NA
❑ NE
Comments (refer to question f: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r)AA*v- at-eA &-kL 17, rw-4 PIXOtV T 7W�, s �
Reviewer/Inspector Name "IF-- Phone: lY 3 D
Reviewer/Inspector Signature: Date: &-
12128104
-12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes jo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EZNo ❑ 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 [0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 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
[RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E`No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[Z No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
91 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CgNo
❑ 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
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

Type of Visit 4n-Go`mpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit GHT6utine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -Y% Arrival Time: 3 Departure Time: Uta County: Region: L�(2
Farm Name: Owner Email:
OwnerName: ,ffGt ee Y i Phone:
Mailing Address:
Physical Address:
Facility Contact: /u S Title:
Onsite Representative:
Certified Operator: _a'T -- /7'
Back-up Operator:
Location of Farm:
Phone No:
Integrator:11 "oll
Operator Certification Number:
Back-up Certification Number:
Latitude: E::]'
=' =" Longitude: ❑ o =' = u
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
9[ No
urren#
DesiERR
Design Curren#
❑ Yes
Design
Current
❑ NE
Swine ulation
Wet Poultry Capacity Population
Cattle
Capacity
Population
&No
❑ NA
❑ Wean to Finish
❑ Layer
❑ Dai Cow
-Wean to Feeder (P S'0
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
��
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co wi
--
1-1 Turke s
Other
❑ Other
❑ Turkey Pouits
10 Other
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
9[ No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
El Yes
�No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number: — Date of Inspection S�-3 _ ''
' Waste Collection & Treatment
V 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ANo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
SNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
RNo
❑ 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?
10 Yes
[]"No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
14 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E No
ZN
[:1NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) �t,V
13. Soil type(s) AgA
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
29 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes
10 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
RNo
❑ NA
❑ NE
Comments (refer:to,question #): Explain any YES answers and/or any recommendations or any other comipents r ��
additional
Us drawings of facility to better explain. {use
Ilpages as necessary):
Reviewer/Inspector Name I ✓ r"_ Phone: a— .3.3
Reviewer/Inspector Signature: Date: ® 3a io
Page 2 of 3 11128104 Continued

Facility Number: — Date of Inspection 3 0
{� Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 04No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2! -No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists
❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 15 -No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
MNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2"S1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JXNo
❑ 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
gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
R1No
❑ 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
MNo
❑ 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
CKNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;K No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

f Type of Visit &Compliance Inspection O Operation Review O lagoon Evaluation t
Reason for Visit 19 Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access If
Facility Number (� Date of visit: /a �I°� T..: Ia:1 �
O Not rational Q Below Threshold
Permitted 12 Certified 0 ConditionaUy Certified © Registered Date -Last Operated or Above Threshold•
Farm Name: 611 fru s N' -c rSet # County• c.7 c�ai�cs.� - Feb
Owner Name: /Jari y Q J Phone No:
Mailing Address: _ _ . . �? _� -� o r JV . ,M s� .._ . �. s. '�1i -p j "elul AJ .. /10C C,�3 7
Facility Contact: ._____ _— Phone No:
Onsite Representative: kaJ44 j6"43_aZ•_ _ _ Integrator. �'1�� . igo
rwou
Certified Operator: 1912 r r Alva des Operator Certification Number: '4"
Location of Farm:
OSwine ❑ poultry ❑ Cattle ❑ Horse Latitude • K Longitude ' �u
DiscbarRes 8 Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes �w No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? A11,4
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes j No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _– % _ --- . _ .^ __ .. _ _
Freeboard (inches): 0? !l f
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
Yes
❑ No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
❑ Yes
I 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 maintenancerunprovement?
❑ Yes
[P No
8. Does any part of the waste management system other than waste structures require maintenance/impmvement?
❑ Yes
Z] No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
0 Yes
BO No
elevation markings?
Waste Apoliration
10. Are there any buffers that need maintenancerunprovement?
❑ Yes
E$ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �jerrr7 �[ �Q /� s►-t+c. l ( a ra i ti O.5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
EP No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
[ No
c) Ibis facility is pended for a wettable acre determination?
❑ Yes
[p No ,
15. Does the receiving crop need improvement?
❑ Yes
Q No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[W No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
9 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
EX -No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
O No
Air Quality representative immediately.
[7 Field Copy ❑ Final Now
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✓ Gs- f-�S - % �I O
Reviewer/inspector Name
LZ
Reviewer/Inspector Signature:
12111103
Date: /1/20
Continued

Facility Number: p 9 — q Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 10 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 14 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes [X No
27. Did ReviewerAnspector fail to discuss reviewlinspection with on-site representative? ❑ Yes IQ No
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause nonecripliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes O No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no fnrther correspondence about this visit.
j.0 15
ANN .-
, .,.»
L
1,2/12/03