260011_INSPECTIONS_20171231

�VR
NORTH CAROLINA
Department of Environmental Qua

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 260011 Facility Status: Inactive
Permit: AW1260011
E] Denied Access
Inspection Type. Compliance Inspection
Inactive Or Closed Date:
Reason for Visit. Routine County:
Cumberland Region:
Fayetteville
Date of Visit: 07/31/2018 Entry Time: 09:30 am Exit Time: 11:45 am Incident 9
Farm Name: Pate Farm
Owner Email:
Owner: W Carey Pate
Phone:
910483-1674
Mailing Address: 5836 Butler Nursery Rd
Fayetteville NC 28306
Physical Address: 5836 Butler Nursery Rd
Fayetteville NC 28306
Facility Status: Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude:
34` 54' 52" Longitude:
78° 49' 34"
South of Gray's Creek. From NC 87, east on Blossom Rd (SR 2233) to T. Left (N) on Butler
Nursery Rd approx. 0.3 miles. Farm
entrance on west side (left).
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator:
Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Doris Pate
Phone:
On -site representative Doris Pate
Phone:
Primary Inspector. Bill Dunlap
Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
Both lagoons at 84 inches or more freeboard. Was accompanied by Mitch Miller. We took samples of the mostly solid material in
the bottom of the lagoon to make another attempt at clean out and closure.
page: 1

Permit: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 0 0
Total Design Capacity: 0
Total SSLW
page: 2

Permit: AW1260011 Owner- Facility : W Carey Pate Facility Number. 260011
Inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No No No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑M
❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0110
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?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑M
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
■ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑M
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑M
❑
❑
maintenance or improvement?
Waste Aanlicatlon
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
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: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes
No Na Ne
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
N ❑
❑
Management Plan(CAWMP)?
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
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
E ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No Na Ne
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?
❑
E ❑
❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
E ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

,-A
Permit: AWI260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yee
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
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
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■ ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
01113
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?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yea
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
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?
❑
M ❑
❑
(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 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33: Did the Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

In
I
0 Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 260011
Facility Status: Inactive
permit; AW1260011
Denied Access
Inppection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for Visit: Routine
County:
Cumberland Region:
Fayetteville
Date of Visit: 07/31/2018 Entry Time: 09:30 am Exit Time: 11:45 am Incident #
Farm Name: Pate Farm
Owner Email:
Owner: W Carey Pate
Phone:
910-483-1674
Mailing Address: 5836 Butler Nursery Rd
Fayetteville NC 28306
Physical Address: 5836 Butler Nursery Rd
Fayetteville NC 28306
Facility Status: Compliant ❑
Not Compliant Integrator:
Location of Farm:
Latitude:
34° 54' 52" Longitude:
78° 49' 34"
South of Gray's Creek. From NC 87, east on Blossom Rd (SR 2233) to T. Left (N) on Butler Nursery Rd approx. 0.3 miles. Farm
entrance on west side (left).
Question Areas:
Dischrge & Stream Impacts
Waste Col, Stor, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Dons Pate Phone:
On -site representative Doria Pale Phone:
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspoctor(s):
Inspection Summary:
Both lagoons at 84 inches or more freeboard. Was accompanied by Mitch Miller. We took samples of the mostly solid material in
the bottom of the lagoon to make another attempt at clean out and closure.
page: 1

Permit: AWI260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 0 0
Total Design Capacity: 0
Total SSLW:
page: 2

I
Permit: AWI260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yee
No Na Na
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑M
❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑ ❑
25. Is the facility out of compliance 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?
❑
0 ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑ ❑
Other
Yes
No Na No
28. 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,
❑
❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑M
❑
❑
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
❑
❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Permit: AWI260011 Owner - Facility : W Carey Pate Facility Number: 260011
inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Dlacharges & Stream_Impac%
Yes No No No
1. Is any discharge observed from any part of the operation?
❑
01111
Discharge originated at: r
Structure
❑
Application Field
❑
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)?
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?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection Stora e & Tre tment
Yee No No No
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (l.eJ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
S. 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 ApRilgatio
Yes No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
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: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 07/31/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No Na Ne
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
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?
17. Does the facility lack adequate acreage for land application?
❑
E ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes 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?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

if
ti
� I YY�S 16-10- 1�7 S-�
Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 260011 Facility Status: 111ULAIVe Permit: AW1260011
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Cumberland Region:
Data of Visit: 10/10/2017 EntryTime: 10:00 am Exit Time: 11:00 am
Farm Name: Pate Farm
Owner: W Carey Pate
Mailing Address: 5836 Butler Nursery Rd
Physical Address: 5836 Butler Nursery Rd
Faclll Status•
N.
Incident d
Owner Emall:
Phone:
Fayetteville NC 28306
Fayetteville NC 28306
❑ Denied Access
Fayetteville
910-483-1674
❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 34° 54' 52" Longitude: 78° 49' 34"
South of Gray's Creek. From NC 87, east on Blossom Rd (SR 2233) to T. Left (N) on Butler Nursery Rd approx. 0.3 miles. Farm
entrance on west side (left),
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On-Sito Representative(s): Name Title Phone
24 hour contact name Carey Pate Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(e):
Inspection Summary:
Mr. Pate has passed away. No hogs have been present for several years. An attempt was made to dean out the lagoons and
close them, ending the permit in early 2016, that failed due to miscommunicaiton.
I need to hear from the new owners as soon as possible regarding what they want to do about closing out the lagoons and
ending the permit as soon as possible.
Bill Dunlap
910-433-3334
page: 1

Permit: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 10/10/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 0 0
Total Design Capacity: 0
Total SSLW:
page: 2

Permit: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 10/10/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Dischames & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑ ❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ ❑
■
b. Did 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 observable adverse impacts or potential adverse impacts to Waters of the
❑
❑ ❑
■
State other than from a discharge?
Waste Collection, atoraae & Treatment
Yee No Na No
4. Is storage capacity less than adequate?
❑
❑ ❑
0
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
❑ ❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑ ❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑ ❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑ ❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑ ❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 1313
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 AW1260011 Owner - Facility W Carey Pate Facility Number
260011
Inspection Date: 10/10/17 Inppection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes
No Na Ne
Crop Type 1
Corn, Wheat, Soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Tarboro
Soil Type 2
Deloss
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑ ❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑ ❑
18 Is there a lack of properly operating waste application equipment?
❑
❑ ❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑ ❑
E
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page 4

Permit: AWI260011 Owner - Facility : W Carey Pate Facility Number. 260011
Inspection Date: 10/10/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
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)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]
❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
1111
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
[]
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
[] ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ ❑
Otherlssues
Yes
No No No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑ ❑
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,
❑
❑ ❑
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 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ ❑ ❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative? 011110
34. Does the facility require a follow-up visit by same agency? ❑ ❑ ❑
page: 5

d�ia�o��°
Co "2t�7
i�

RECEIVEDINCDEQI WR
Notification of Change of Ownership
�V O g ?017
Animal Waste Management Facility
(Please type or print all information that does not require a signature)
Water Quality Rel;jiotial
In accordance with the requirements of 15A NCAC 2'T .1304(c) and 15A NCAC 2T .1305(d) this form �si€fieii#hnoti>i'Eatjgnry
to the Division of Water Resources (DWR) of the transfer of ownership of an Animal Waste Managemein Facility. This
form must be submitted to DWR no later than 60 days following the transfer of ownership.
General I forma i r : r
Previous Name of Farm: �IC- ' ` f't-L Facility No:
Previous Owner(s) Name: tj, (ire �o%etos�i Phone No:
Now Owner(s) Name: 4=,2 G_ LC _ Phone No:
New Farm Name (if applicable):
Mailing Address: v t / C f� Z e iv id
Farm Location: Latitudr; and Longitude: 3 �/ SY sZ / 7 $'� 1 r psi « County: eu ►� �t�dw
Please attach a copy of a county road map with location identified, and provide the location address and driving directions
below (Be specific: road names, directions, milepost, etc.): CAN S-C L2-23 (rw s C"arc '
S r3G 6 '. y. ��lYppnr� /2s�•.aP bCI(r c— ' t .30 .
Oj)eration Description:
7ype afSwine No. offlnimals Type of Swine No. of Animals Type of Cattle Na, of Animals
❑ Wean to Feeder ❑ Gilts ❑ Dairy
❑ Wean to Finish ❑ Boars ❑ Beef
❑ Feeder to Finish
© Farrow to Wean Type of Poultry No. of Animals
21-arrow to Feeder _ © Layer
❑ Farrow to Finish ❑ Pullets
Other Type of Livestock: Number of Animals:
Acreage Available for Application: S_ T, Required Acreage: / �r
Number of Lagoons / Storage Ponds: Z 'Total Capacity: S �`�` 3 Z Y Cubic Feet (0)
Owner / Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing. 1 (we) understand the operation and
maintenance procedures established in the Certified Animal Waste Management Plan (CAWMP) for the farm named above
and will implement these procedures. I (we) know that any modification or expansion to the existing design capacity of the
waste treatment and storage system or construction of new facilities will require a permit modification before the new
animals are stocked. I (we) understand that there must be no discharge of animal waste from the storage or application
system to surface waters of the state either directly through a man-made conveyance or from a storm event less severe than
the 25-year, 24-hour storm and there must not be run-off from the application of animal waste. I (we) understand that this
facility may be covered by a State Non -Discharge Permit or a NPDES Permit and completion of this form authorizes the
Division of Water Resources to issue the required permit to the new land owner.
Name of Previous Land Owner
Signature:
Name of New Land Owner.:
Signature: _ ly , Z--t �
Name of Manager (i€ different from owner)
Date:- I 1 I Z - _
Signature: Date:
Please sign and return this form to:
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699-1636
June 12,2015

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Animal Waste Management Systems
Request for Renewal of Existing Individual State Non -Discharge Permit
Please do not leave any question unanswered.
Facility Number.:
2 facility Name:
3 Landowner's name (must match the name on the Cer'tilicd Animal Waste Managcment flan);
Landowner's Mailing address:.
Email address (ifapplicable):
5 County where facility is located: 419 44
6 Farm Manager's name (if different from Landowner): �
7 Farm Manager's telephone number (include area code);
8 Farm Manager's email address (il'applicable):
9 Number and Type ol'Animals: (example: 2000 Feeder
Swine: — Q % '"',
Confined Cattle:
.r
Poultry with liquid waste system:
Other:
Finish Swine
I c;, A, eA- A Pl
Submit a copy of the most recent Waste Utilization Plan with this application. The Waste Utilization Plan roust be signed by
the owner and a technical specialist.
1 attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge. l understand that if
all required parts o1'this application are not completed and that if all required supporting information and attachments are not included,
this application package will be returned to me as incomplete. Note: In accordance with NC General Statutes 143-215.6A and 143-
215.613, any person who knowingly makes any false statement, representation, or certification in any application may be subject to
civil penalties up to $25,000 per violation.
Printed Name ol'Signing Official (Landowner, or if multiple Landowners all landowners should sign. I1'Landowner is a corporation
signature should be by a principal excculLve officer of the corporati)44�:
z
v� V f�f
Signature: t`C� . � (� Date: •�,� • � / /
THE' COMPLETED APPLICATION SHOULD BE SENT" 1'O'I HE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER RESOURCES
ANIMAL FEEDING OPERATIONS
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE: [phone] FAN: [phone]
Request for Renewal - Individual 11.13.2014

' F -3 *A
115�lr
CCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
March 27, 2012
W. Carey Pate
Pate Farm
5836 Butler Nursery Road
Fayetteville, NC 28306
Natural Resources
Subject: Permit No. AW1260011
Pate Farm.
Animal Waste Management System
Cumberland County
Dear Mr. Pate:
Dee Freeman
Secretary
In accordance with your application received March 26, 2012, we are hereby forwarding to you this
Permit issued to W. Carey Pate authorizing the operation of the subject animal waste management
system. You had indicated the animal population at this facility to be zero until such time as the waste
storage lagoon at this facility is properly closed.
This approval shall consist of the operation of this system including, but not limited to, the management
of animal waste structures on the Pate Farm, with an annual capacity of no greater than an annual
average of zero (0) Swine.
The Permit shall be effective from the date of issuance until February 28, 2017 and replaces the COC No.
AWS26001 I issued to this facility on October 1, 2009. You are subject to the conditions of this permit
until the closure of all waste storage basins and the rescission of this permit. You must submit a letter to
the Division of Water Quality to request rescission of the Permit by providing documentation of closure
of all containment basins.
The issuance of this Permit does not excuse the Permittee from the obligation to comply with all
applicable laws, rules, standards, and ordinances (local, state, or federal) nor convey any property rights
in either real or personal property.
Per 15A NCAC 2T. 0111(c), a compliance boundary is provided for the facility and no new water supply
wells shall be constructed within the compliance boundary. Per NRCS standards, a 100-ft separation
shall be maintained between water supply wells and any lagoon, storage pond, or any wetted area of a
spray field.
Please be advised that any violation of the terms and conditions specified in this Permit may result in
revocation of this Permit or penalties in accordance with NCGS 143-215.6A through 143-215.6C, the
Clean Water Act, and 40 CFR 122.41, including civil penalties, criminal penalties, and injunctive relief.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
Internet www.ncwatemua&.o[g
An Equal Opportunity 1 Affirmative Action Employer
One
MfthCarofina
awra!!y

If you wish to continue the activity permitted under this Permit after the expiration date of this Permit, an
application for renewal must be filed at least 180 days prior to expiration.
This Permit is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
This facility is located in a county covered by our Fayetteville Regional Office. The Regional Office
Aquifer Protection Staff may be reached at [phone]. If you need additional information
concerning this Permit, please contact the Animal Feeding Operations Unit staff at [phone].
Sincerely,
or Charles Wakild, P.E.
cc: Cumberland County Health Department
Cumberland County Soil and Water Conservation District
Fayetteville Regional Office, Aquifer Protection Section
Ms. Fran McPherson, DWQ Budget Office- Please waive the overdue fees.
Notebook File AW1260011
Permit File AAM60011

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
INDIVIDUAL SWINE ANIMAL WASTE MANAGEMENT SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
W. Carey Pate
Cumberland County
FOR THE
continued operation and maintenance of an animal waste management system for the Pate Farm, located
in Cumberland County, consisting of zero (0) Swine and the application to land as specified in the
Facility's Certified Animal Waste Management Plan (CAWMP).
This permit shall be effective from the date of issuance until February 28, 2017 and shall be subject to the
following specified conditions and limitations:
I. PERFORMANCE STANDARDS
The animal waste management system operated under this Permit shall be effectively
maintained and operated as a non -discharge system to prevent the discharge of pollutants
to surface waters, wetlands, or ditches. Application of waste to terraces and grassed
waterways is acceptable as long as it is applied in accordance with Natural Resources
Conservation Service (NRCS) Standards and does not result in a discharge of waste to
surface waters, wetlands, or ditches. If the Facility has a discharge of waste that reaches
surface waters or wetlands resulting from a storm event more severe than a 25-year, 24-
hour storm, it will not be considered to be in violation of this Permit, as long as the
Facility is in compliance with its CAWMP and this Permit.
2. No discharge of waste shall result in a violation of the water quality standards established
for receiving waters as per Title 15A, Subchapter 213, Section .0200 of the North Carolina
Administrative Code (NCAC) and Title 15A, Subchapter 2L of the NCAC.
3. The facility's CAWMP is hereby incorporated by reference into this Permit. The
CAWMP must be consistent with all applicable laws, rules, ordinances, and standards
(federal, state and local) in effect at the time of siting, design, and certification of the
Facility.

4. Any proposed increase or modification to the annual average that exceeds the thresholds
set by North Carolina General Statues (NCGS) 143-215.1013(1) will require a
modification to the CAWMP and the Permit prior to modification of the Facility.
5. Animal waste shall not be applied within one hundred (100) feet of any well, with the
exception of monitoring wells. The allowable distance to monitoring wells shall be
established on a case -by -case basis by the Division.
I1. OPERATION AND MAINTENANCE REQUIREMENTS
The collection, treatment, and storage facilities, and the land application equipment and
fields shall be properly operated properly and maintained at all times.
2. A'vegetative covee shall be maintained ag specified -in the Facility's CAWMP on all land
application fields and buffers in accordance with the CAWMP. No waste shall be
applied upon areas not included in the CAWMP.
3. Soil pH on all land application fields must be maintained in the optimum range for crop
production.
4. Land application rates shall be in accordance with the CAWMP. In no case shall land
application rates exceed the agronomic rate of the nutrient of concern for the receiving
crop. In no case shall land application rates result in excessive ponding or any runoff
during any given application event.
5. If manure or sludges are applied on conventionally tilled, bare soil, the waste shall be
incorporated into the soil within two (2) days after application on the land. This
requirement does not apply to no -till fields, pastures, or fields where crops are actively
growing.
6. Pesticides, toxic chemicals, and petroleum products shall not be disposed of in the animal
waste management system.
7. Domestic and/or industrial wastewater from showers, toilets, sinks, etc. shall not be
discharged into the animal waste management system. Washdown of stock trailers
owned by and used to transport animals to and from the Facility only will be permissible
as long as the system has been evaluated and approved to accommodate the additional
volume. Only those cleaning agents and soaps that are EPA -approved according to their
labels, will not harm the cover crop, and will not contravene the groundwater standards
listed in 15A NCAC 2L may be utilized in the Facility covered by this Permit.
Instruction labels are to be followed when using cleaning agents and soaps.
Disposal of dead animals resulting from normal mortality rates associated with the
Facility shall be done in accordance with the Facility's CAWMP and the North Carolina
Department of Agriculture and Consumer Services (NCDA&CS) Veterinary Division's
statutes and regulations.
9. Unless accounted for in temporary storage volume, all uncontaminated runoff from the
surrounding property and buildings shall be diverted away from the waste
lagoons/storage ponds to prevent any unnecessary addition to the liquid volume in the
structures.

10. A protective, vegetative cover shall be established and maintained on all earthen
lagoon/storage pond embankments (outside toe of embankment to maximum pumping
elevation), berms, pipe runs, and diversions to surface waters or wetlands. Trees, shrubs,
and other woody vegetation shall not be allowed to grow on the lagoon/storage pond
embankments. All trees shall be removed in accordance with good engineering practices.
Lagoon/storage pond areas shall be accessible, and vegetation shall be kept mowed.
11. At the time of sludge removal from a lagoon/storage pond, the sludge must be managed
in accordance with the CAWMP. When removal of sludge from the lagoon is necessary,
provisions must be taken to prevent damage to the lagoon dikes and liner.
12. Lagoons/storage ponds, shall be kept free of foreign debris including, but not limited to,
tires, bottles, light bulbs, gloves, syringes or any other solid waste.
13. The Facility must have at least one of the following items at all times: (a) adequate
animal waste application and handling equipment, (b) a lease, or other written agreement,
for the use of the necessary equipment, or (c) a contract with a third party applicator
capable of providing adequate waste application.
14. No waste shall be applied in wind conditions that might reasonably be expected to cause
the mist to reach surface waters or wetlands.
15. The Permittee shall maintain buffer strips or other equivalent practices as specified in the
Facility's CAWMP near feedlots, manure storage areas, and land application areas.
16. Waste shall not be applied on land that is flooded, saturated with water, frozen, or snow
covered at the time of land application.
17. Land application of waste is prohibited during precipitation events. The Permittee shall
consider pending weather conditions in making the decision to land apply waste.
18. Land application activities shall cease on any application site that exceeds a Mehlich 3
Soil Test Index for Copper of greater than 3,000 (108 pounds per acre) or Zinc of greater
than 3,000.(213 pounds per acre)..
19. Any major structural repairs to lagoons/storage ponds must have written documentation
from a technical specialist certifying proper design and installation. However, if a piece
of equipment is being replaced with a piece of equipment of the identical specifications,
no technical specialist approval is necessary [i.e. piping, reels, valves, pumps (if the
gallons per minute (gpm) capacity is not being increased or decreased), etc.] unless the
replacement involves disturbing the lagoon/storage pond embankment.
III. MONITORING AND REPORTING REQUIREMENTS
An inspection of the animal waste collection, treatment, and storage structures, and
runoff control measures shall be conducted and documented at a frequency to insure
proper operation For example, lagoons/storage ponds, and other structures should be
inspected for evidence of erosion, leakage, damage by animals or discharge.

Highly visible waste -level gauges shall be maintained to mark the level of waste in each
lagoon/storage pond that does not gravity feed through a free flowing transfer pipe into a
subsequent structure. The gauge shall have readily visible permanent markings. The
waste level in each lagoon with a waste level gauge shall be monitored and recorded
weekly on forms supplied by, or approved by, the Division.
3. A representative Standard Soil Fertility Analysis, including pH, phosphorus, copper, and
zinc, shall be conducted on each application field receiving animal waste at least every
three (3) years. An analysis of the animal waste shall be conducted in accordance with
recommended laboratory sampling procedures as close to the time of application as
practical and at least within sixty (60) days (before or after) of the date of application.
This analysis shall include the following parameters:
Nitrogen Zinc
Phosphorus Copper
4. The Permittee shall record all irrigation and land application event(s) including hydraulic
loading rates, nutrient loading rates and cropping information. The Permittee shall also
record removal of solids and document nutrient loading rates if disposed on -site or record
the off -site location(s). These records must be on forms supplied by, or approved by, the
Division.
5. If, for any reason, there is a discharge from the animal waste management system
(including the land application sites), to surface waters or wetlands, the Permittee is
required to make notification in accordance with Condition III.9. The discharge
notification shall include the following information:
a. Description of the discharge: A description of the discharge including an estimate of
the volume discharged, a description of the flow path to the receiving surface waters
or wetlands and a site sketch showing the path of the waste. Also, an estimation of
the volume discharged.
b. Time of the discharge: The length of time of the discharge, including the exact dates
and times that it started and stopped, and if not stopped, the anticipated time the
discharge is expected to continue.
c. Cause of the discharge: A detailed statement of the cause of the discharge. If caused
by a precipitation event, detailed information from the on -site rain gauge concerning
the inches and duration of the precipitation event.
d. All steps being taken to reduce, stop and cleanup the discharge. All steps to be taken
to prevent future discharges from the same cause.
e. Analysis of the waste: A copy of the last waste analysis conducted as required by
Condition III.3.
6. A copy of this Permit, the Facility's permit, certification forms, lessee and landowner
agreements, the CAWMP, and copies of all records required by this Permit and the

Facility's CAWMP shall be maintained by the Permittee in chronological and legible
form for a minimum of three (3) years.
Within fifteen (15) working days of receiving the request from the Division, the
Permittee shall provide to the Division one (1) copy of all requested information and
reports related to the operation of the animal waste management system. Once received
by the Division, all such information and reports become public information, unless they
constitute confidential information under North Carolina General Statutes (NCGS) 132-
1.2, and shall be made available to the public by the Division as specified in Chapter 132
of the NCGS.
The Division may require any additional monitoring and reporting (including but not
limited to groundwater, surface water or wetland, waste, sludge, soil, lagoon/storage pond
levels and plant tissue) necessary to determine the source, quantity, quality, and effect of
such waste upon the surface.waters, groundwaters or wetlands. Such monitoring,
including its scope, frequency, duration and any sampling, testing, and reporting systems,
shall meet all applicable Division requirements.
9. Regional Notification:
The Permittee shall report by telephone to the appropriate Division Regional Office as
soon as possible, but in no case more than twenty-four (24) hours following first
knowledge of the occurrence of any of the following events:
a. Any discharge to ditches, surface waters or wetlands.
Failure to maintain storage capacity in a lagoon/storage pond greater than or
equal to that required in Condition V. 2. of this Permit.
C. Over applying waste either in excess of the limits set out in the CAWMP or
where runoff enters surface waters or wetlands.
Failure of any component of the animal waste management system resulting in a
discharge to surface waters or wetlands.
e. Any failure of the animal waste management system that renders the Facility
incapable of adequately, receiving, treating or,storing the waste and/or sludge.
Any deterioration or leak in a lagoon/storage pond that poses an immediate threat
to the environment or human safety or health.
For any emergency, which requires immediate reporting after normal business hours,
contact must be made with the Division of Emergency Management at 1-800-858-0368.
The Permittee shall also file a written report to the appropriate Division Regional Office
within five (5) calendar days following first knowledge of the occurrence. This report
shall outline the actions taken or proposed to be taken to correct the problem and to
ensure that the problem does not recur. The requirement to file a written report may not
be waived by the Division Regional Office.

IV. INSPECTIONS AND ENTRY
1. The Permittee shall allow any authorized representative of Department, upon the
presentation of credentials and other documents as may be required by law and in
accordance with reasonable and appropriate biosecurity measures, to:
a. Enter the Permittee's premises where the regulated Facility or activity is located or
conducted, or where records must be kept under the conditions of this Permit;
b. Have access to and copy, at reasonable times, any records that must be kept under the
conditions of this Permit;
c. Inspect, at reasonable times any facilities, equipment (including monitoring and
control equipment), practices, or operations regulated or required under this Permit;
and,
d. Sample or monitor, at reasonable times, for the purpose of assuring permit
compliance, any substances or parameters at any location.
V. GENERAL CONDITIONS
1. The issuance of this Permit shall not relieve the Permittee of the responsibility for
compliance with all applicable surface water, wetlands, groundwater and air quality
standards or for damages to surface waters, wetlands or groundwaters resulting from the
animal operation.
2. The maximum waste level in lagoons/storage ponds shall not exceed that specified in the
Facility's CAWMP. At a minimum, maximum waste level for lagoons/storage ponds
must not exceed the level that provides adequate storage to contain a 25-year, 24-hour
storm event plus an additional one (1) foot of structural freeboard except that there shall
be no violation of this condition if: (a) there is a storm event more severe than a 25-year,
24-hour event, (b) the Permittee is in compliance with its CAWMP; and{c) there is at
least one (1) foot of structural freeboard.
3. Any containment basin, such as a lagoon or a storage pond, used for waste management
shall continue to be subject to the conditions and requirements of this Permit until
properly closed. When the containment basin is properly closed in accordance with the
Natural Resource Conservation Service (MRCS) North Carolina Standard for Closure of
Waste Impoundments, February 2005 or any subsequent amendment, the containment
basin shall not be subject to the requirements of this Permit. The Permittee must submit a
letter to the Division to request rescission of the Permit by providing documentation of
closure of all containment basins.
Closure shall also include a minimum of 24 hours pre -notification of the Division and
submittal of the Animal Waste Storage Pond and Lagoon Closure Report Form to the
address identified on the form within fifteen (15) days of completion of closure.

4. Failure of the Permittee to maintain, in full force and effect, lessee and landowner
agreements, which are required in the CAWMP, shall constitute grounds for revocation
of its COC to operate under this Permit.
5. This Permit is not transferable. In the event there is a desire for the Facility to change
ownership, or there is a name change of the Permittee, a Notification of Change of
Ownership form must be submitted to the Division, including documentation from the
parties involved and other supporting materials as may be appropriate.
6. The issuance of this Permit does not prohibit the Division from reopening and modifying
the Permit, revoking and reissuing the Permit, or terminating the Permit as allowed by the
appropriate laws, rules, and regulations.
7. The Groundwater Compliance Boundary is established by 15A NCA02L and 15A
NCAC 02T .011 l (c). An exceedance of Groundwater Quality Standards at or beyond the
Compliance Boundary is subject to the requirements of 15A NCAC 2L and the Division
in addition to the penalty provisions applicable under the NCGS.
Vl. PENALTIES
Failure to abide by the conditions and limitations contained in this Permit; the Facility's
CAWMP; and/or applicable state law; may subject the Permittee to an enforcement
action by the Division including but not limited to the modification of the animal waste
management system, civil penalties, criminal penalties, and injunctive relief.
2. The Permittee must comply with all conditions of this Permit. Any Permit
noncompliance constitutes a violation of state law and is grounds for enforcement action;
for Permit coverage termination, revocation and reissuance, or modification; or denial of
Permit coverage renewal application.
3. It shall not be a defense for a Permittee in an enforcement action to claim that it would
have been necessary to halt or reduce the permitted activity in order to maintain
compliance with the conditions of this Permit.
This Permitissued.the!27th day of March, 2012. , T ,�
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Charles Wakild, P.E., Director
North Carolina Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number AW1260011

i�
Division of Water Resources
Division of Soll and Water Conservation
0 Other Agency
Facility Number: 260011 Facility Status: Inactive Permit: AW1260011 Denied Access
Inspaction Type: Compliance Inspection Inactive Or Closed Dale:
Reason for Visit: Routine County: Cumberland Renton. Fayetteville
Date of Visit: 12/22/2016 EntryTime: 11:00 am Exit Time: 11:59 am
Farm Name: Pate Farm
Owner: W Carey Pale
Mailing Address: 5836 Buller Nursery Rd
Physical Address: 5836 Butler Nursery Rd
Facility Status
Incident #
Owner Email:
Phone:
Fayetteville NC 28306
Fayetteville NC 28306
910-483-1674
= Compliant Not Compliant Integrator:
Location of Farm: Latitude: 34° 54' 52" Longitude: 78' 49' 34"
South of Gray's Creek. From NC 87, east on Blossom Rd (SR 2233) to T. Left (N) on Butler Nursery Rd approx. 0.3 miles. Farm
entrance on west side (left).
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On-Slte Representative(s): Name Title Phone
24 hour contact name Carey Pate Phone
On -site representative Carey Pate Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Farm has been empty for several years. Houses tom down. Attempt made to dean lagoons and close. Failed because they were
too dry. Recommend a dip and haul or some other method to close out lagoons.
page: 1

Permit: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 12/22/16 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Swine
Design Capacity Current promotions
Swine - Feeder to Finish 0 0
Total Design Capacity: 0
Total SSLW:
page: 2

A. ti
Permit: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 12/22/16 Inssection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na Me
1, Is any discharge observed from any part of the operation?
[]
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑
❑
b. Did 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)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
■ ❑
Cl
3, Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yoe No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 0 []
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: AWI260011 Owner - Facility : W Carey Pate Facility Number:
260011
Inspection Date: 12/22/16 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes
No Na Ne
Crop Type 1
Corn, Wheat,
Soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
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
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
NO
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
N ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
E ❑
❑
Records and Documents
Yes
No Na Ne
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?
❑E
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
0 ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AW1260011 Owner - Facility : W Carey Pate Facility Number: 260011
Inspection Date: 12/22/16 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yee
No Na, No
Crop yields?
❑
120 Minute inspections?
[]
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑M
❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑ ❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge?
❑
❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ ❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑
❑
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?
❑M
❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ 0 ❑ ❑
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? ❑ 0 ❑ ❑
page: 5

vision of Water Resources
Facility Number - O Division or Soil and Water Conservation
O Other Agency
Type of Visit: O,Cumpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: + S Arrival Time: 19!3aA Departure Time: 1 County: Cc, vt i,�' 14 Region: l—1 ZO
Farm Name: C"Ie y �a Owner Email:
Owner Name: tj t C-& P'cV rca4C Phone:
Mailing Address: S g 3 � R'Jfe.� N U'e r3 1`�a�, �' e �CUt•I�t !r G ��&0 4
Physical Address:
Facility Contact: _ cXL'f* t a Title: Phone:
�I
Onsite Representative:
q
Integrator:
Certified 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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Non-L
Pullets
Turkey Poults
Other
Design Current
Diseharzes 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes 0'110- ❑ NA [] NE
❑ Yes ❑ No D1A ❑ NE
❑ Yes ❑ No ff0NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [30 A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes �o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes F!rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

kacility Number: - Date of lns ection: o�c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [311A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): VV Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 Ir 1 o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3<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
<o
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[10"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
dNo
❑ 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): 2 e-vS
13. Soil Type(s): V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C2'9'o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1=J 1Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1 Na
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'5o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�To
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ErNo
❑ NA
❑ NE
the appropriate box.
0Wi1P ❑Checklists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
rVrNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
[] NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
io ❑ 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
Vo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[R l"o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2Yo
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
10
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
❑ Yes [/] No
❑ Yes ErNo
[]Yes 0No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers grid/or any'additional recommendations :or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
C m LPr-�_ Pe_CAA_
h CW- O -,'VVLt r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1�J J
Date: 3 .&r _ 15
2/4/2014

Division of Water Resources
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: �outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:'(. Arrival Time: Departure Time:L_LI�J County: W0 Region:
Farm Name: PQA f Owner Email:
Owner Name: /J Phone:
Mailing Address: 5 �3 ,;'� /%�✓«-�, (L�f'
Physical Address:
4to•V e, Mr,` Z?3DG
r
Facility Contact: Title:
Ons€te Representative: C�
Certified Operator: _ AO
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator: _AIA
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
s
A
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
t'ou
lets
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes []No C9 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [3 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 DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes
[:]No
[2<A
❑ NE
❑ Yes
[]I'o
❑ NA
❑ NE
❑ Yes
[ 10
❑ NA
❑ NE
Page I of 3 21412014 Continued

JIFacA Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZLbia.—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No R;�*A ❑ 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 an; of the structures observed?
❑ Yes
[aia
❑ 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
[f],V O
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[a_ND._
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[5-5o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[-]Yes
Zlo
❑ 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): I o
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑L .Aim
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9-N-o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F; oo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Q,Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D. o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
[]PIA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
[ A
❑ 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
Q No
A
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Exo"'
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

1Pacili Number: b - Date of Inspection: _
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues .
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[g,Ko ❑ NA ❑ NE
�Ko❑ NA ❑ NE
❑ Yes
[]I'<o
❑ NA
❑ NE
❑ Yes
LN"o
❑ NA
❑ NE
❑ Yes
E:>o
❑ NA
❑ NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes EErNo ❑ NA ❑ NE
❑ Yes E31�0 ❑ NA ❑ NE
❑ Yes C�<a
❑ Yes [2,f,;o
[:]Yes ff No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
N o Nods '
en �„, ✓� Veer.
.TAM&arb.�dys�r��C-fl�� I�oo„:�pK��y
do S,�o�F�..�,
% I 'N'f
G �� s CL+ 04- tv l t t
1 1 �
4l L'4t A. JCe o J [rid ,{ �%tri.l� 4. +v �'1.W swc'o
�
P 4 '
Reviewer/Inspector Name: t 1 Phone:
4
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

1gvs
-14 Division of Water Quid ty Ne50Wt f j
Facility Number l - O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit: &Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: GMoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: jjjJjArrivalTime: Departure Time: County: SRegion:
Farm Names . } Ui-L 6M Owner Email:
Owner NameX Coo "ct4p— Phone:
Mailing Address:
Physical Address:
Facility Contact: Q Title: _�wtNg- Phone:
OnsiteRepresentative:- Integrator: _K)la=
Certified Operator: �{,Y}E_. Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feedcr to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
rou
Non-L
Pullets
Poults
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stockcr
Beef Feeder
Beef Brood Cow
[:]Yes to No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 21412011 Continued

'acilit$lumber: oZ - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
❑ No
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
E;�NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
t' NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r1 Y✓h
13. Soil Type(s): mrtm I g$
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
�0 Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
❑ WUP [:]Checklists [:]Design [:]Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to No
❑ 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 WNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
® NA ❑ NE
Page 2 of 3 21412011 Continued

Vacili 'Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check W Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: N_7.+r1�1
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[]No
®'NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[]No
PNA
❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[:]No
f;�NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
'R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[]Yes
&RI 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).
Zoo foeulai a, fam fi-. Form has bm, d.epplakt set.&al y-eaeu,.
All waa-1r� v��m�,� ho b&,,, r-AnovpL wH� no Pam' available-19vfld, shave -ea At)
lFWf cre 6A out rP v 1 t- ` (I v1n d o wn a
L�l s ar&sUf b N RC S . 7 cofzhave, a 1 idle. wg-/e /1
b -H o�,� rl, r1, emfr j °n - yeJ C�`A�101,. kn ks GYG beoff , 'M s1de bo r,1f.
�o'sa)Lq- iopi 1od' o �vo�r,, e leaks an bonkj,
01yr& is kepj� roIh1� o remlds,
Reviewer/Inspector Name: —,To
Reviewer/Inspector Signature: %-e 9J Q4
Page 3 of 3
Phone: gILYE-�te)
Date: 1
21412011

n1 f Ivr I D Ia-11i,
Division of Water Quality
Facility Number ®- QQ 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: (StCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (2-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other i0 Denied Access
Date of Visit: _ b 3 E Arrival Time: j Departure Time: 9 : / County: C(,/l?�1 IA Region: _F/
Farm Name: Pal P Fa/,y, Owner Email:
Owner Name: ('�y Phone:
Mailing Address:
Physical Address:
Facility Contact: ► Y , L Title: ©wn Pr Phone:
Onsite Representative: .Q y Integrator: t) l —
Certified Operator: 0_ 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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: @42- Date of Inspection:
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _1CL _jam
Observed Freeboard (in): 65
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes W No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Arc 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? 10 Yes [:]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2 No
❑ NA
0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require CRYes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ •Frozen Ground ❑ Heavy Metals (Cu,.Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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?
Reaulred Records & Documents
CR Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
V NE
❑ Yes
U No
❑ NA
❑ NE
❑ Yes [2 No ❑ NA ❑ NE
CR Yes ❑ No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? & Yes ❑ No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Cg Yes ❑ No
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application CRWeekly 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 No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No
Page 2 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
® NA ❑ NE
21412011 Continued.,

a— +
Facility Number: -
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes
the appropriate box(es) below.
❑ No ®'NA".MlE
❑No []NA ❑NE
® Failure to complete annual sludge survey Failure to develop a POA for sludge levels
RINon-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 P NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No N NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
5'NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
" No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
W 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
❑ No
❑ NA R] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No
❑ NA ❑ NE
Comments (refer to question #): 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).
Fvri I i� hay )" rofd � rtol4-oq has bee, ode"Jam `Q�qeq-al yea�./r.,,Pha�P1 hare_
m e L( m� har b�e'e rem vP o Z If ';') 1 n a
YVb7jt rjDr1 JJ3�°k oog-fal hPrn�44k Y Q&sM119faM 0verrrfd. P6rm6-.6 e Uj ate.
IfQ,eA fn o-Corr/-When--soybea, rofa/j(,
rvger jS Yvothl� ` vvi- h NRCS o Y+ Ur a. sl dye_ moma�P�t PISay�_
Oloje, laves bv`fi bids have, no+yef be?,, ICI-
ownfr ►vo, keefj? roh-fall re(o'ds bob Sys -ivr IN- )Vhe' h,`i*vc4 Illax4l,p)
fay} rvft k, Ldjco, Ise ve ore Hof be ,eft bv� be vAr ore vel low o4d r)o--
` t covPr boffan. y
hon Yyee M0ivect `Wce� 11 yyi^� Ohr?pr, CY YVOQ I'�! i���ef�ia�►Pc�
^ bo,ks e, yr f C r tare w` .
Qi fIde. ba, �. Tie. a� ei p 1 oq w J�oP VL s�abt Ire
liowq 1 efM_Whf' I V CIOS'U/G 1S �n �aqqf SS��
rmsmio,T)�f
ole n�a� odKf copy ; J�alkfcLio Zorr S- o�`0eCLrn�larrd Co. Nl2CS � t ola3l� ka hoM� 1�o1-4
h v +o ,g2�- e i a9av Cl Ard-i� 9 r fd f W mai nv� h#M W� j I * lv f l f r, Sj�te, pvloo y Ffb -)o, a
rne,gWq 1^OYlfi�l�/���ebmoo��m rro� mAr�r�L� nr, �a�c.m IOlarcl la.
Reviewer/Inspector Name: QnLd1 �r Phone: 91a.433. ;30(01f{f
Reviewer/Inspector Signature: - Date: 0f x 0) 0 �a
Page 3 of 3 21412011

hype of visit: iZ1v[;ompuance inspection tV uperation Keview U atructure tvaivation U i ecnnicat Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:;? Departure Time: County: CAktbj Region: EQ
Farm Name: bCj _ Foye , Owner Email:
Owner Name: YY, i� &14. Phone:
Mailing Address:
Physical Address:
Facility Contact: !IV, && Title: '0)y Phone:
Onsite Representative: Integrator: n lo�
Certified Operator: �/Q('� �� (jp� Certification Number: I7QrQ T _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
C•uttle Capacity I'op.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
1]rF P.oultr►
Ca ac
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
[+Other
-Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ 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
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
tgNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

]Facility Number: L - 11 1 jDate of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes kl'No CD NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes R 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 5g 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? 5' Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Callo
❑ 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): Com , �' p! Sm bpat
13. Soil TYpe(s): b171D o f�
14. Do the receiving crops differ from those designated in the CAWMP? R`Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:].Yes t'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JR No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
g Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
® NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
ONE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
®, NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
&3'NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
V:. Did the facility fail to calibrate waste application equipment as required by the permit? JgYes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check aYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
(Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
'RINon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: aQaz I as -- �jTr
26. Did the facility fail provide documentation of an actively certified operator in charge'? ❑ Yes '® No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C'No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
INo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
ONE
33. Did the Reviewer/Inspector tail to discuss review/inspection with an on -site representative?
❑ Yes
';'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES 'ans'wers`and/or any: udditional r,66immendations or:any;'othcr coMMcnts ' k
Use drawings of facility to better ex lain situations.(usendditional pages as necessary-)-`:
:FLifol has ,d a 4� nog (ss
ct�ea� abof-v® haw- f'alied owe
GV e, w r�eab (, Pore -hair b6 1 years,
�re�e fimD;aO � � .SC�I n�aC f a►-� `�o<rn . ��i� ,'t n Q
Urn I� C� nett , ` nfr IS' 00*-Of i hvahesj W_ does not r f a w i'01
oreds G�� �Ie �Ce,,.}_, r
Lo O&s of Ovi0 COn I'ance- Oil near[ dried y w`� c� dew Odles ,7�i�n d
IM C1a� elmat
7 `�
� s�Js
?1ea�eVd
row la Nrim
�rfN ice
, D haj b ro �h ry o4 weee&
rm y� aI-j' de $oa� o, Amf1' rf Ada a r � w/(
f � � � h �e �i� a � eat' , l
cht ; f�r's. � is ��� ale 00111`er h" somel ®�-�►���,
�1 %� --►- �� E�� awn�J J c9 �
aU L o lam` n
orm�r��j-Preid1 Die now soy�r G�td� %a,,l�o�.
C.MAWA d6r;f71� Y* abov; 01 ownt- cofr-7.
Reviewer/Inspector Name: Qa�, � ht)iP1'Pr _ Phone: $16— ��3 Q1 1
1
Reviewer/inspector Signature: Date:
Page 3 of 3 21412011

.jFaCility No. Farm Name Pak l __ Date
Permit COC OIC
Pop.
Type
Design
Current
NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
n
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
Design Flow
NOV. 13
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu-1 Zn-I
Needs P
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
urop Y iela i ransrer oneets
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt Ib/1000 Gal
H
RAIN GAUGE
Dead box or incinerator
Mortality Records
:.
..
..
1-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO glgloyf Date last WUP at farm
FRO or Farrecprds
Lagoon # RJY4 I
Top Dike -50
Stop Pump %
4 8
Start Pump 4guL(,
1
Conversion- 000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
LPW a��fi isys
w�9 Ca�ir`�,
App. Hardware
r ti q �!D cno, yctl �3'�q 3� �s r
[.aya �. ��s orn� j
3 a�xo
iv
sir ytm, dog -,Jtlbk�
-704o'tt0e- + � 1� lk�i<14cap- 3)zE�Wb,PY
c 1jerf)qj

emirs 2-0'Y- 0 0 / 0
ivision of. Water Quality
Facility Number Z(p J -_ / O Division of Soli and Water Conservation
-- 0 Other Agency
Type of Visit 9<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date or visit: Arrival Time: Departure Time: Z : 2$ County: Cy"�6er�N d Region:
Farm Name: ?!t Fa""^• Owner Email:
Owner Name: CCLV-e. j PA+e_ Phone: -
Mailing Address:
Physical Address:
Facility Contact: Cur fi 5 +� av is (C Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: = o
Operator Certification Number:
Back-up Certification Number:
u ❑0=' ="
Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
99fecder to Finish /700 1 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other �^
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
aply Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ID
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
NA
❑ NE
[I Yes
El No
B<
El NE
D<Ao
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
LSO
❑ NA
❑ NE
12128104 Continued

Facility Number: 2&
Date of inspection12--02-/Ol
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): T 2-1+ 2!0
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 No ❑ NA ❑ NE
❑Yes 3 o ❑NA ❑NE
Structure 5 Structure 6
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes M<o ❑ 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 2' o ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MINo ❑ 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 El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) I3 C V_MkCt 0— ((fiat' Sw,1( C M , t t O. S . --
13. Soiltype(s) R �-Lov-o e.(Uss _��,��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,L�T, oo [I NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes E7No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 3-< ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes i[3- o' NA El NE
18. is there a lack of properly operating waste application equipment? El Yes i_iiTo ❑ NA ❑ NE
Comments refer to question Ez� lain ab YES: answers a'ndloi an recommit dat ons or` an�otl cr c mtnents:
( q ) P Y y Yp h e L
Use drawings of facility twbetfer explain situations: (use�additiunal pales as necessary)` 53
ReviewerlInspector Name �i GIC " R�iJ 2 r+5 �' s Phone: C7ID. Y3 j. 334)O
Reviewer/Inspector Signature: Date: .2 -dZ-- ZolO
12128104 Continued

Facility Number: 26 -- // Date of Inspection z-oZ- f0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists [I Design El Maps El Other
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B No
❑ 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 ❑ Wcather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D 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
ErN.
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
" No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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?
El Yes
,, /
ETNo
❑ 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
El Yes
,�,,�
1J No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewcr/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ETNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
l a wo
❑ NA
❑ NE
Additional Co"mment"s$and/tii•Drawings
12128104
12128104

r-
ET—W -5 e-m. w "3 io -- a Z — z00 `f
vision of Water Quality
Facility Number 26 // 0 Division of Soil and Water Conservation
-- — Q Other Agency
Type of Visit &
tompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 9~ Z/-Q �% Arrival Time: Departure Time: .2 ;,gyp County: d2vi""O J ul Region: / 40
Farm Name: ALL kAwl -- Owner Email:
Owner Name: Caee.4 !%k— Phone:
Mailing Address:
Physical Address: `/
Facility Contact: eyrlf Aywr`cj<- Title: 71ed • SAe-� Phone No:
Onsite Representative: C�tt+'�'S '��w+Z� Integrator: e-Y ,e -A
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wetri to Feeder
EYTeeder Finish
JOYIZQQ
I /7r
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other— -- ---- — - -
Operator Certification Number:
Back-up Certification Number:
Latitude: 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I :[=�l
❑ Non -Layer
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?
Longitude: 0 o = ' =
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [` No ❑ NA ❑ NE
❑ Yes
❑ No
B NA
❑ NE
❑ Yes
❑ No
BIN'A
❑ NE
[3- A
❑ NE
❑ Yes
El No
❑ Yes
IN//o
❑ NA
❑ NE
❑ Yes
L7No
❑ NA
❑ NE
12128104 Continued

Facility Number: 26—
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes 15N��o
❑ Yes 2<0
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 7-3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 3< ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures 6n-site which are not properly addressed and/or managed ❑ Yes Er—?10 ❑ 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 [5'110 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes DNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) .,�
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement`?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes l_TNo ❑ 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) ge-trlk- Gra,',a
13. Soil type(s) 7—a►'6QVo . bC. loSS �
14. Do the receiving crops differ from those designated in the CAWMP? El Yes B o . ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes G o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ONo ❑ NA [I NE
17. Does the facility lack adequate acreage for land application? El Yes [3 o ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
.•,;;;."€ r r >, r:q t �.` ba,C,a."h � -.-
Comments (refer to�questian `#): l✓xplalmany'YIJS irnswersand/nr any recommentlations for uny othe.rcamments
Use drawings of facility to licfter.explain.situatiods. (use addrtlon�il pages as nc essAr�y) 6 .
Rr ` ' `�' '_' Phone: *0. 'V33.333 Sf
Reviewer/Inspector Name fi t�C 1'Z� v.. e,�S
:..
Reviewer/Inspector Signature:Date:
12128104 Continued

}
Facility Number; 2(0 — / Date of Inspection F9-2/- b
Required Records ,&„Documents �,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L7 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP 0 Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 3 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 o
[I NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElL7 Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3' o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B' o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ck<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
05o
❑ 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
015o
❑ 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
El2 Yes
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
E No
Er
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ETNo
❑ NA
❑ NE
12128104

5•fwL (uct4� �� G�...r,Ia•'...t a..► S�IS�aB
q--o y -d 8 leg
(A -Division of Water Quality
Facility Number 2 (p j 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $-ZO'4$ Arrival Time: 1 Sa Departure Time: County: S`t"' 14 Son/ Region /—%2d
Farm Name: �a�e— FQrw— Owner Email:
Owner Name: A�—c Pete Phone:
Mailing Address:
Physical Address:
Facility Contact: tr u r T.�_ k—_ Title: Phone No:
OnsiteRepresentative:�^+w��k Gc l�{ c-r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = e ='
= Longitude: = o = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non —Layer I EEI
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
/ 70 o
16 S-0
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0-<o- ❑ NA ❑ NE
❑ Yes,
❑ No
EIITA'
❑ NE
❑ Yes
❑ No
O'15A
❑ NE
glq'r
❑ NE
❑ Yes
❑ No
❑ Yes
91goo
❑ NA
❑ NE
❑ Yes
❑-ido
❑ NA
❑ NE
Page I of 3 12128104 Continued

Y;
Facility Number:
Date of Inspection 0-20-0 0
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 P StructurcV Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z `f 3 2
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 No ❑ NA ❑ NE
❑ Yes LalNo ❑ NA ❑ NE
Structure 5 Structure 6
El Yes 35o [I NA [I NE
❑ Yes 0`5o ❑ 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 2"ivo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes 0'5a ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require []Yes �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,7 N�,�—
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Lo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0-N-o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Croptype(s)ci.w�:.��ot-, ��i� �w..�l•j G+r�,., �D�S�
13.
Soil type(s) A e (o s
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2 0
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
3'�lo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
N/o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
,._,
E �o
ElNA ❑ NE
t8.
Is there a lack of properly operating waste application equipment? ❑ Yes
D
❑ NA ❑ NE
Reviewer/inspector Name s`` K �/ Q, (.5 a a§ Phone: qlO, I.A33. 3334
Reviewer/Inspector Signature: Date: ff — 7- 0 —ZOOS
Page 2 of 3 12128104 Continued

Date of inspection
Facility Number: $2 — / C -2d v
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ��❑,,'1CNo El NA El NE
ElLT
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other �,�
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes o ❑ 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 2 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0-5o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
aTVoo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2 0
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0-o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9-lq-o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2N-o-
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D-MU
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O'hTo
❑ 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
2-No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspcctor fail to discuss review/inspection with an on -site representative?
❑ Yes
❑`lam
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2iio -❑ NA
❑ NE
AdditionalCommentsand/orLc
Dru►vings
' f
���
F , ; b f:
�i i� i _ '
Page 3 of 3 12128104

A
VDIvision of Water Quality��
Lacl].HyNumber ! Q Division of Soil and Water Conservation
0 Other AgencyC�
F
peof Visit ompliance Inspects n O Operation Review O Structure Evaluation Q Technical Assistance
ason for Vlslt 0 Routine 6Complaint O Follow up C) Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: o'a County:
pU�> Farm Name: : T..Lr_'ri— Owner Email:
Owner Name Phone: _
Mailing Address:
/ G�p7►
Region: f ��y
Physical Address:
Facility Contact: Title: Phone No: _;K6P_0
Onsite Representative: �� tt-7'L� pa� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = i Longitude: ❑ o = 1 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
JZ Feeder to Finish
/ O o
3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes 5qNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P,No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
Page I of 3 12128104 Continued

4
Facility Number: 1 Date of Inspection Lt7 ' —W
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes DRNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
4
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
J9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? es
[9No ElNA @f4t
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Eallo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA J4 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ACM--L
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
Ryes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
NNo
❑ NA
E
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
2kNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ff): 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):
,J
y{j r Cam e K� d"rnD/�Ya� 7-0 >!Sr d i t4 ivex % -ry e -emA-ol. AJo Wajte
�l cY,f X errt
xvpt`r�i-►t-
W",rx 4n W>c s.,,) Alo
ReviewerfInspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: d4 — = Date of [nspection S-11
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [Z NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA 19 NE
the appropirate box, [] WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [9 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA 4NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
MNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
® NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
9NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QKNo
❑ NA
[,:1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[IYes
ElNo
❑ NA
I�NE'
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
R 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
PSNE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
® Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
r G l� I
16i/1 G9 F &A,
74-
FWyll Alt,
�
w
12128104

f
G Division of water Quality
Facility Number 2 (p j 0 Division of Soil and Water Conservation
0 Other Ageney
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: is-d5-07 Arrival Time: /O;DDAna Departure Time: County: `� �eY��^ra Region:
Farm Name: P44t► =,y, Owner Email:
OwnerName: Phone:
Mailing Address:
Physical Address:
Facility Contact: C AV his a(k V w i C_ V_ Title: 45"NV. � V � Phone No:
On site Representative: -,Cut*S Integrator: Co�aV� hC-✓r.�l-r
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Latitude: 0
Back-up Certification Number:
0 Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
/ D D
8 7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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?
Design Current:.''`_
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
[I Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [;NNo ❑ NA ❑ NE
❑ Yes
n No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P No
❑ Yes
[ja No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

i
r
Facility Number: Z Lv —
Date of Inspection /G OS 07
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
Structured StructurcO Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z 3S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
9 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
12 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
00 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) }l3 e—ir r64 vw c� (I' '7 $�wa /� A-It"M (0, S7.
13. Soil type(s) Dt /arkory
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[;5 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
Fil No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other: comments
.Use drawings of facility to better explain situations,. (use additional pages as necessary):
7
Reviewer/[nspector Name l�RP-4, 9/0. V33 -330 0
^�Phone:
Reviewer/Inspector Signature: Date: /0 —051-zOe7
Page 2 of 3 12128104 Continued

4
Facility Number: 2 (v — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 17 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
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
99 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[XINo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. 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:
12128104

Division of Water uality
=E=:
mber Z rp r Division of Soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Jr O/np6 Arrival Time: Departure Time: � County: Curse&ie&&- aft Region:
Farm Name: PA+ G F4 V w� Owner Email:
Owner Name: _ C L tr ! Q qi4 -e— ,_ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1/jf'rj! Ca e- Co 11 i C_ Title: Phone No:
Onsite Representative: Integrator: 4f0kC0_ Z raV"A�$
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = 6 = 6{ Longitude: = ° ❑ 1 = 1{
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�� ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non —Layers
❑ Puilets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any.part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes (,7No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
LINE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑Yes
(9No
.❑NA
El NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection a5- o/-
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 I Structure 2 ➢ Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): y
Observed Freeboard (in): 23 -2
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 29 No ❑ NA ❑ NE
❑ Yes 09 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes DQ No ❑ NA ❑ NE
❑ Yes N 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 QjNo ❑ 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 5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (g No El NA El NE
maintenance/improvement?
t L Is there evidence of incorrect application? If yes, check the appropriate box below., ❑ Yes N 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) 8tKA ttkc1 r'_ Wo' �A Si+Ac_ t I (av e-VS c.t_.CL
13. Soil type(s)
t4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination.;[:] Yes
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
N No
❑ NA
❑ NE
Comments[ referr�tn��question #} Explain any�Yl+,S �nswersAendlor any recnmmendatluns or any other comments.
Use drawinuf;facaility�tn better explain�situatlons�(useladditivnal^pages�was,necessary.'):
Reviewer/Inspector Name `�'.r , '�3 �: ��
i. G is v t� � � e Phone: D� �
Reviewer/Inspector Signature: Date: DS- 0/ — ZOO
12128104 Continued

Facility Number: 'Z(o — (1 Date of Inspection aS-01—d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
[]Yes
EgNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE .
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ® NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[A NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
N NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[0 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
14 No
❑ NA
❑ NE
General Permit'? (iel 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
[M No
❑ NA
❑ NE
1aditional Comments`and/or Drawings:
12128104
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 3 : pU Departure Time: County: Cl-niAu_14kN Region: P0JkI
Farm Name: P. f- P.,. r Owner Email:
2v
Owner Name: _ �,�s � a r r c �, a f-�„ � Phone:
Mailing Address: ar cs Oe—neof IC17 7` e v"ll e , /�C. _ �i�3D 6
Physical Address:
Facility Contact: Title:
Onsite Representative: __ Cu_" iris_ ' /V" e.lkz'
Certified Operator: co//,'c.-
Back-up Operator:
Phone No. -
Integrator: C. k a,1 G
Operator Certification Number: !!@r /7v
Back-up Certification Number:
Location of Farm: Latitude: ❑ a ❑ 4 ❑11 Longitude: = o ❑ 1
Design
Current
Design Current`
r &
'= �, �' Destgn'
Current
Swine Capacity
Populativn
Wet Poultry Capacity Population
Cattle
CRHap city
PopJul�ation
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La et
❑ Dahy Calf
Feeder to Finish
/741 °
1sj"e�
❑ Dairy Heifej
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other1
1
10 Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
10 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1] No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

. c
Facility Number: Date of Inspection 3 7— os
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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
❑ Yes [M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Designed Freeboard (in): .R. e� ' ,� n D 4i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[7 No
❑ 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
9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑'Yes
Da No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
[rYes
[:)No
❑ NA ❑ NE
❑ Excessive Pond ing ❑ 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. Crap type(s) _ Qe!rr►+t-�.R��� 6z
13. Soil type(s) % n A L3e,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
© No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21 No
❑ NA ❑ NE
.. ".�Y4�/Y'11.rs_!�p S.rN .may 'b';, � {. 'F e $ �� J e .��,.[ ��., to � ) '�Fk s*.�ialR➢d
Cntnments{rel'errto ciuestian�#) �Expiain any�YES"t�nsw�ers and/or;any recommendations or any other comments.
Use drs..win g oftfacili . „ta�,betfer expliiin;situations'�(use�additionhltpagea�}�as necessarfy}:
L�t1�E..�➢:«Lnw6t/^:?ti'a,.
7— Oj J-p pus e- 4.4-4w-"O ft wr. "j 4 Vcu Crab i C4kz O t,,,Q. 4e_.
t1^.ov
ii--
WUaTe_ P -,AC,
n,u.�r b�.-k-c►kcw fir .t-I.c,. u>�o( '�n �i►GLr ��t� da� w�..�1ow�
Reviewerllnspector Name Phone: Iflei
Reviewer/Inspector Signature: Date: 3 as"
6�-- . ✓ 12128104 Continued

r�
Facility Number: — // Date of Inspection 3 op/or
Required Records & Documents
19. Did the faciiity.fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
® Waste Application ❑ Weekly Freeboard O Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yicld ® 120 Minute Inspections ® Monthly and I" Rain Inspections 2OWeather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N1No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[ZNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Qa No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
50 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
ER No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
J1
.d r3C fir. r O t ! �b �- rvL
�` CJ�1Kl ►^ G
is aq TIC
P� r Y�+,�'�
�i:
i�. �� I
12/28/R4

.. Y rEt•i. '.- d '.,€, .,,.;. _'-"". .va-..a„ca.:t.r.. ...-,.7°+-`,<t, s.-:".€a�—� ! Ett--¢pas ;- °€ 3 Ei_ a s ri�ia 1. €rE�,j'isa
IV1Sltin'.t11l�ki�i�atCr Kf ,k 1�E �,f i, !I �., a ii { L➢s�r< r i IIX f. '1=
� r-1if.4., 1
11dnWSteFiC6 eI'YatiOrl ta'r.,?f, { ? r,,..,€i �<F �E. !a ;�'a`�i�it..it'.#.:
€7 ;.f , ! �: a<�¢ ll,,;.,:•,' ''$h s�;3t"=P I [tpe`:Y:.rlaeukt'°Yi aq 3, €xt�,�s ':P.i,}t � .� ji i"}<gg<°„ �" j•rt;i.;::-j: °I e <-.t<t>=> : tr €'F.#� ,ip € I l €::,,�i t6 -.
Er
i)t11fe�°A
w J. t,Gf
�.'X1.4��fr 4%°'..-y •�! . .. ... �.�:,, a.....
Type of Visit 90tompliance Inspection p Operation Review O Lagoon Evaluation
Reason for Visit QAroutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time. E=
0 Not Operational O Below Threshold
13 Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ................ ».......
FarmName: ........ .. .... ......P .................................................. County:.........SrN!!^! �..�d^.........................................
OwnerName:........ W:.....4„�.............P'01C................................... ............... Phone No:..... 0.`. b........................................
Mailing Address: ...... .7.,Q X. .,,���. K......... ...K d ................. ................ ...l.rV �.1k..............%1ft.�r.............. ..?�.���...
Facility Contact: ........... ,fr! 4 .......... 0�! �t!Q....... itle: .................... one No :...................................................
Onsite Representative: ....... !r.. R.II.!.. ..f.c.!!!r.]C'..!" Integrator:...»... R.1W 1...................................................
CertifiedOperator: ................ WA! fe.......................................... Operator Certification Number:..........................................
Location of Farm:
[twine ❑ Poultry ❑ Cattle ❑ Horse
i Design'aCu•r
SwineCuacf �PoulP
Latitude F-19 & 64 Longitude • 4 44
r
❑ W to Feeder
1:,,.
❑ Layer
eeder to Finish
pp'
❑ Non -Layer
❑ Farrow to Wean
;,.:...ti
,: a,:
I
❑ Other
❑ Farrow to Feeder
❑ Farrow to FinishDeSi
E,Tot8lrI
❑ Gilts
i
❑Boars
I
I
'? ir.l>, i Number of Lagoons f [ £t-
Discharges & Stream Impacts
I
1. Is any discharge observed from any part of the operation? ❑ Yes�o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did itreach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? E] Yes Leo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes two
Waste Collection & Treatment �
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes @44
Structure 1 Strut 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... r...... ............................./`+................ .................................... ................................... ......................................................................
Freeboard (inches): .� ;Lo
12112103 Continued

Facility Number: — Date of Inspection
Reguired_Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35, Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 421go
❑ Yes WO
❑ Yes Mof4o
❑ Yes [�No
❑ Yes YNo
❑ Yes 20ONo
❑ Yes �No
❑ Yes eNo
❑ Yes [+ O
❑ Yes 2To
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Facili$y Number• Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes RP0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Ovo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes []1R0
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes R<o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes M4go
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes M No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑'l T�o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ 4ith those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes [205o
14. a) Does the facility lack adequate acreage for Iand application?
❑ Yes [`No
b) Does the facility need a wettable acre determination?
❑ Yes RTNo
c) This facility is pended for a wettable acre determination?
❑ Yes [rNo
15. Does the receiving crop need improvement?
❑ Yes �lo
16. Is there a lack of adequate waste application equipment?
❑ Yes Rf' o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes [+r10
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes [+N10
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes M<O
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 2<0
Air Quality representative immediately.
;.Comments' refer'to`5/�uesti n # sExR'la�n ai {� Y answers'and/(or any,rlecommendadons:gr an '� th'er.co men•.' ii'�'.t $ �i'`}°i ;i'ryy'•
°;de r;'i IE(,j.E.>i:- *9.�iE7: a. -... €..i'eP'ix 11 �1.;€,'.'�:'1adt 10 �,Ii�� f)asi9•a4°`iPl { �5i34:��i �$E d'..t?.iii; �1,V: ..,�f1 ���3N.v$.i23�9��.iEi�f. i9.. ..u4nEw«,H:Gsn y�.iiiFi:ii�F1�W3Xi
!Use 66win& ofofaclwty to'better I E; �
explain,srdrations'(use:idditioiW pages'asryAecessary): field Co Final
.. ,, te.Y 1 ✓ .. :i d �.. Y{, G '� N rIl CH. Copy ❑
Notes .•
X `
.{' •'pr',.
.'-', y ffn'' ;i• 1{'. .} Yy I
. s t _nr1;?`h�1�iN�
F i�
n Mr .
J ✓ �S,
y
Reviewer/Inspector Name ;
Reviewer/Inspector Signature:
Date:
12112103 /J Continued

! ,.. �Fy t J 4 i 9 3' •� �. t � Y 4 t .i u t 1 1�1 I I j...7 F � 7 { "d, .}.i {� 3 � ��3 7 1.i`t tf
=.� «-��,�'•,� �hL�1�,et1Cj!,7i��..a��l a� Eat �ar��=�' fn tli `Edd
a5_�w�
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility.Number Date of Visit: 1� 3 Time:
-
Nat O erational Below' Threshold
® Permitted ® Certified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County: C ,,-y6zA6,y,9
Owner Name: 61, c G L, 617f. Phone No: q t O
Mailing Address: - A : g3G _(3cu+ PU— —1f34
Facility Contact: _ i kcr— Title: Phone No:.
Onsite Representative: 4 i C k 4?.f Integrator:
Certified Operator: 4 Operator Certification Number: f -0
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑Horse Latitude Longitude �• �• �••
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Population
❑ Wean to Feeder 10 Laver ❑ Dairy
® Feeder to Finish D ❑ Non -Laver ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons _ ' ❑ Subsurface Drains PresentDiEl La oon Area ❑ S rav Field Area
holding Ponds /Solid Traps Q _ ❑ No Liquid Waste Management Svsiem
Dischgroes 8 Strellm JmRacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in Sal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4. Structure 5
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [,B-No
❑ Yes 5 No
❑ Yes ES No
Structure 6
ldentifier:
Freeboard (inches): 1 ��
05103101 r� G A L J' _ _ ^ Continued
bQ d.0 hc� c�IC.L i C ► jQ l4a " i"c -'-.

Facility Number: a — ji I Date of Inspection t
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes Q[ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [R No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes '9No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [@ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes allo
12. Crop type (3Nrr.n utgL_ .F- X4.-n e) , .S .
13. Do the receivingcrops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? .-
p g g [I Yes EkNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. is there a lack of adequate waste application equipment? ❑ Yes [FNo
Reguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q,No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
LNNo
(ic/ discharge, Freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
6No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[gNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[p No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain a1hy YES answers and/or any recommendations or any other Comm_ eats:
Use,drawings of facility to better explain situation5> (use additional pages a neres's`ary)
, t ❑ Field Copy ❑ Final Notes
f L y
Reviewerlinspector Name d
Reviewer/inspector Signature: ja Date:
O5103101 d— l Continued

J
V
Facility Number: Date of inspection �O�J
LUM Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
® Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes [R No
❑ Yes No
❑ Yes No
® Yes ❑ No