430004_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: a Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: r eparture Time: County: a r Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: f"h Title: Phone:
Onsite Representative: y Integrator: pres,4042.
Certified Operator: Certification Number:
/ a
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design
Ca aci"t
Current
Ipo
Wet !'cult
Design
Ca sett
Current
Poi
Cattle
Design Current
Ca Po
P`
,
6r���sra I
Belt P ,
r�rt sr tt
D (llgNy
_
�nimri.
to altr:y
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Q
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dry l'oult . ,
Ca Bcit ;
I'o ..,
Non -Dairy
Farrow to Finish
I
La ers
Beef Stocker
Lilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other,I
lTurkeyPoults
Other
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Discharges and Stream lmuacts
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)? _
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 q9 No ❑ NA ❑ NE
❑Yes
No
1]NA
❑NE
❑ Yes
❑ No
EA NA
❑ NE
❑ Yes
❑ No
23 NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
to No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

t
Facility Nuif ber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
O)NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed
Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[?!�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
tpNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�?No
❑ NA
❑ NE
maintenance or improvement?
TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
j hNo
❑ NA
❑ NE
maintenance or improvement?
T"
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [] NA
❑ Excessive Pending ❑ 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 Crog Widow ❑ FjjidencAof Wind 94Y ❑ ANlicatipn Oulkide of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ,[�] No
❑ Yes TpNo
Yes i No
❑ Yes No
❑ Yes No
❑ Yes rWNo
[:]Yes No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ Yes ® No
❑ NE
❑NA
❑NE
[]NA
❑NE
❑ NA
❑ NE
❑NA
ONE
❑NA
❑NE
❑ NA ❑ NE
❑ NA ❑ NE
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

lFachity Nurhber: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
09 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
IM No 0 NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
1�No ❑ NA ❑ NE
permit? (i.e., discharge, frceboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
V No 0 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
No NA ❑ NE
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Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

' • Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
p Other Agency
type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine () Complaint C) Follow-up C) Referral C) Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �.' 1Q[,(� �'J� Owner Email:
Owner Name. 1'—L9 Phone:
Mailing Address:
Physical Address:
Facility Contact: LD a lac-* T� Title: Phone:
Onsite Representative: Integrator: res
2�k e
Certified Operator: Certification Number: t I �
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
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Dry F,
Layers
Non-L
Pullets
Other
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
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes NJ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ` No
;9NA ❑NE
0 NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Page 1 of 3 21412011 Continued

Facifi Number: - Ll jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13 3
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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
% No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EP 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 ® 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 Chop Window �+❑ Evid9nce of Wind Dri
ft ❑ Application Outside ofApprovedArea
12. Crop Type(s): � 1 �G�Ci �ts5 //�Vi��+�/, fh" iyiZt�c� �'�f
13. Soil Type(s): I,ectd
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?
❑ Yes
[Z 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
P 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
M No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: 77T Z7, jDate of Inspection:
�4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 5D No
the appropriate box(es) below. '
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes No
❑ Yes No
0 NA
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
[:]Yes 0 No [] NA ❑ NE
❑ Yes R] No ❑ NA ❑ NE
[:]Yes P No ❑ NA ❑ NE
[:]Yes [�g No [] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
FU
tiients (refer to question #): Explain any YES answers and/or auy:additionM recommendations or;any other comments
dravvings of facility; to b.etter'explain:situations(use additional-pages.as necessary). „ ,
Robe✓ Yvtarble -owl
ceU 9�b-62N-NoNI
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �'�0-�33:�
Date: 'I'��/ T
21412011

Q C t
ivision of Water Quality
;'Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: p,Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I County: E�1le Region:
Farm Name: L J2Lo.-chr�� Owner Email:I If
Owner Name:
Mailing Address:
6710
Phone:
Physical Address: zn Z.3
Facility Contact: T� Title: Phone:
Onsite Representative: ` i Integrator: IDS
Certified Operator: l Certification Number:
Back-up Operator: Certification Number:
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
Latitude:
Design Current \ Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
pry routrry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No [EYNA ❑ NE
❑ Yes [:]No [3-NA ❑ NE
❑ Yes [:]No
❑ Yes R'o
❑ Yes To
EfNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
NV�ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [n'No ❑ NA [3 NE
a. If yes, is waste level into the structural freeboard? []Yes [3N No [*AB ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity
of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(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 [K;,Pdo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �10 ❑ 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 [n"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes t0' ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [5 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cc/wVt,e,»C� vd.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C `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
[E'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[40No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[rNNo
❑ 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
1
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
r
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of inspection: cc
2eDid the facility faA to calibrate waste application equipment as required by the permit? ❑ Yes g],I�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes To ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Cn N ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
QX
❑ NA
❑ NE
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?
❑ Yes
L;Ko
❑ 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
EaoNo
❑ 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
53<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4DAo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[EpNo
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments y I
Use drawings of facility to better explain situations (use additional pages as.necessary). -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L, J4110 Phone:
Date: at
21412011

ivision of Water Quality
Facility Number - VI UU `11 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Q),eo—mpiiance Inspection p Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (k'1To_utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 18 Arrival Time: Departure Time: G County: Q G Region:I
Farm Name: 1 4&
7-�
Owner Name: L ZD 91&cA
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: L i•./ Title: Phone:
Onsite Representative: `� Integrato1PL'-:'S-
Certified Operator: Certification Number:
1ZG2G
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Nan -La er
ury t'oultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees 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
MNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[J A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit +Number: - Date of Inspection;
Waste Collection & Treatment ,�,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I _3 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q]
❑ 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
e No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[E'Ko
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P-N9
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E5<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[] Outside of Acceptable Crop Window ❑ Evidence of Win Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3 4e" 5;g &o - 1 0- `U� Rew
! r
13. Soil Types): c LN
14. Do the receiving crops differ from those designated in the CA P?
❑ Yes
[]:kiQo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F2<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
240
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
13<0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]INo
❑ NA
❑ NE
Reauired 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 t DXo' ❑ 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 [TWo ❑ 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 &3<
171,❑ NA ❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VN ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faefli Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E PW ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0,<o ❑ 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 [Zjollo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z W ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes []Ko ❑ 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 QXo ❑ 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 [Po ❑ 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 CTNo [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [�r<o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C--"04%.,.4.�r __1 lO - la - l(
sfw ia-a3- ao0-
Reviewer/Inspector Name: V., I t � r
Reviewer/Inspector Signature: Tj
Page 3 of 3
Phon7o qS;— S3�L(
Date: & a t";
21412011

► r7
ur'A
type of visit: Ucompliance Inspection V operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: routine Q Complaint O Fallow -up t) Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: fl County: RIr
Farm Name: Owner Email:
Owner Name: L.D 01 AC.(C Phone:
Mailing Address:
Physical Address:
Facility Contact: �, j� J�r_� Title: !'�,� n r R Phone:
Onsite Representative: X lAC_ a Integrator:
Certified Operator: _ 8 )Ace Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: rxo
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poul�@ b Wi—)a c i RM Pop.
Layer
C•a#tle
DairyCow
Design
C►apacity
C+urrent
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish g
DairyHeifer
Farrow to Wean
Desigil—
D Cow
Farrow to Feeder
17ry P,oultrF C_a aciNon-Dai
ruayers
Farrow to Finish
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Qthe.r
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes [:]No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facility Number: 4'25 - 4 Date of Inspection: d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: id.
['No ❑ NA ❑ NE
G2'No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a (4 2q_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [214o ❑ 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
D"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
E3"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
MNo
❑ 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
2No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [allo ❑ NA 0 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` ❑l Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): H 21 C',
13. Soil Type(s): [ r. Tj2 wff+
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑it ' No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [R'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [allo ❑ 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 [O'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [v�' No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facilit Number: y3 - oU 1Date of Inspection: 4 Il / a 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes DLJ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [yNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [2rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [gNo ❑ 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 orCAWMP?
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 [2 No ❑ NA ❑ NE
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes C No ❑ NA ❑ NE
[]Yes tZNo
❑ Yes CR'No
❑ Yes [VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendations or any other comments )$ s
4 -?
Use drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name: L .� _ S�=_: _�,p� Phone: QjL* 3Cj'(o J ^�
Reviewer/Inspector Signature: Date: 4t/
Page 3 of 3 21412011

din S
0 Division of Water Quality
Facility Number - (J'jf 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit: Qef'Com Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: � County:
Farm Name: z6az_' rM�� Owner Email:
Owner Name:
Mailing Address:
Phone:
Region: /
Physical Address: Facility Contact: t1 t A ;� , �/ac 14 _ Title: e5&jA.,,a r— Phone:
Onsite Representative: /y, '6/aG (1 Integrator• R14
Certified Operator: , , '8ckfnL Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
oars
Other
Other
Certification Number:
Latitude:
Wet Poultry
Design
Capacity
Current
Pop.
Layer
Non -La er
Dry Poultry
Design
Capacity
Current
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?
Page 1 of 3
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2<0 ❑ NA ❑ NE
❑ Yes
❑ No
IJ lit'
❑ NE
❑ Yes
❑ No
I g"'t`
E] NE
[:]Yes [:]No 1A ❑ NE
❑ Yes Vo ❑ NA [] NE
[:]Yes No ❑ NA ❑ NE
21412011 Continued

Facili Number: - 0 Date of Inspection: ?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes E3 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�� �G
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
U3"Ko
❑ 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
�io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E 46
❑ 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
[Ld<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E34o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
L]Ab
❑ 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): jJyll,t, 0.WC]0
13. Soil Type(s):d 1-)ctc kA -
14. Do the receiving crops differ from ose designated in the CAWMP?
❑ Yes
E�Iio
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2r o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Er"'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
FI-14o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[r'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Er<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Q-110
❑ 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 Q01Vo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No E2-146 ❑ NE
Page 2 of 3 21412011 Continued

' Facility Number: -0 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q`Ro ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [E;Xd ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ll2-<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA r "t
Other lssues
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, frechoard 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 CAWMP7
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q o ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
[]Yes [3 o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
BTo
❑ NA
❑ NE
❑ Yes
E2-1Qo
[DNA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, commentsNr'.
Use drawings of facility to better explain situations (use additional pages asnecessary). a .
Reviewer/Inspector
ReviewerlInspector
Page 3 of 3
Phone:
Date: n
114/ O

l
jType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Ij Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: IT., LtN2^1 County:
Farm Name:
Owner Name: L1731ac-
Mailing Address:
Physical Address:
Owner Email:
Phone:
ETRegion: "0
Facility Contact: LD Q Title: Phone No:
Onsite Representative: Integrator:
'P, _ 10
v1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: e Longitude: = o 0
a5 �rde 5�1�Z(o Al 03 n);tee� IZ�;_
1�D�R�►� �1L�1�
Design C►urrent Design Current Design Current
Swine Capacity Population Wet Poultry C►apacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer ❑ Daia Calf
Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean
pry Paultry
El Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
Farrow to Finish
El Farrow
Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
$ NA
❑ NE
❑ Yes
❑ No
[�LNA
❑ NE
El NA
❑ NE
❑ Yes
❑ No
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

i
Facility Number: — 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
Identifier: 1 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35— 30
❑ Yes No ElNA ❑ NE
❑ Yes No P NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes V No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
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 �9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes � No ❑ NA [:I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes r9,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1'0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop. Window Evidence of Wind
Drift ElApplication Outside of Area
12. Crop type(s) S&!Lo4dil M, (V�VkQwseJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ffl No
❑ NA
❑ NE
3�
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ED 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
P No
❑ NA
❑ NE
Comments (refer'to question #}: Explain any YES `answers,and/o `'spy recommepdahons or any other comments '
Use drawings of facility to better explain situations: use additional Oiles as riecessar
xcel� W-1k4�'4
-
Reviewer/Inspector Name I�q(Phone; 10 3-33c0
Reviewer/Inspector Signature: Date: la 0
Page 2 oj-j 12128104 Continued

Facility Number: — Date of Inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E .No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1p No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[FNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
f No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�j No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'�&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Fj�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
El No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
i&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

-P Ims aIDD(oa �s
Division of Water Quality
Facility Number 3 Q�p V Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: "�- [aliq_1f)-' Arrival Time: � Departure Time: County: Region: rkQ
Farm Name:. 1 Qrk Owner Email:
Bit? C
Owner Name: L Phone:
Mailing Address:oa—
Physical Address: n I
Facility Contact: L d facie Z Title: Nfi-er Phone No:
Onsite Representative: Integrator:
Certified Operator: Dill& __ Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: = 0 0 I 0it Longitude: = ° 0 I = it
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-Layet-1
❑ Wean to Finish
❑ Wean to Feeder
Fccder to Finish 5590
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La crs
❑ 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.
❑
pal Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: ELI
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. 1s there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes & No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
18 No
❑ NA
❑ NE
❑ Yes
5rNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — em Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�3 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): q�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes '51No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
U 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
Wo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[&No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Wo
❑ 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) tvpm ' S Q
13. Soil type(s) D 16h±Y 1S Q 110,ed
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[R No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
DI No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yes
CRNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
�tNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A
w
Reviewer/inspector Name ��f3�/ j[ j Phone:'110— O X3111 �
Reviewer/Inspector Signature: Date:
721281ne

i
Facility Number: 43 — Date of Inspection � IU l u�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes _XNo
t6NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5jrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2ZNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5:No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5ZNo
❑ 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
ffNo
❑ 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
ETNo
❑ 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
IffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
{;'No
❑ NA
❑ NE
Addifional Comincntstan%d/[i"r Drywi9
3;100 II, 1 a 0) C Over srl Md a 008
1vcs4d -�u k rno i1 y'g sayl-es r�seach
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w ink CDvr�Cro r)ot+o j[�fa�. � lt2'>D CDId #-
S! 4 n I S ra wok 01(�e 1� a DOS
Page 3 of 3 12128104

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I
400 Flemington Dr
Lake Waccarnaw, 28450.1932
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NC
SPgnsared.Linlf0
SAgnserpd.l,ir11S3
RatmcantAmWmatlgn Compass Potrda
4girrims Pointe
RalayartAwWrnatl2n
CRM consulting in North Now custom homes and
New custom homes and
CRM consulting in North
Carolina lownhomes
townhomes
Carolina
Get heip with your CRM near Wilmington NC B
near Wilmington NC 6
Gat help with your CRM
project here Carolina Beady
Carolina Basch
project here
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MAPC4EiT,
All fights —wed, U.) subject to LictomiWCopyrlght Map Legend
Directions and maps atu informational only, We make no Warranties on the accuracy of their conlent, road conditions or
mute usopllity or orpodillousnasa, You auume all risk at use. MapOuasl and Its suppliers shall not be liable to you tic
any loss or delay resulting hum your use of MapOuesl. Your use of MapOuesl mama you agree to out Terms ot,Vse

Facility No.g3l-MFarm Name 1J10c� FG/M Date
Permit � COC ✓/OIC_ _ NPDES (Rainbreaker
PLAT Annual Cert )
Design freeboard
Observed freeboard (in)__
IRE • • - f 1
,. � � cry � rrv�l� Ral�ryh
Soil Test Date
2Do`f
1 in Inspections
pH Fields
CYield
rape
120 min Inspections
Lime Neededj1,,,
Wettable Acres _��
Weather Codes ✓
Lime Applied
WUP
✓
Transfer Sheets
Cu ✓ .
Zn ✓'
Weekly Freeboard
�-
RAIN GAUGE
Rainfall >1"
Nam
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Aunt
�n
q
570
Vou—
i6
a
wn
1M
�-o
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

Facility Number 9=-aill
Division of Water Quality
O 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 S(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '0 Arrival Time: Departure Time: County: ' Region:
Farm [fame: L`Q� , l!U ilL\, Owner Email:
Owner Name: L C1L Phone:
Mailing Address:
Physical Address: (�
Facility Contact: Lo UG,&— _ Title:
Onsite Representative:
Certified Operator: Ue i &Cick_
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish 15,9710 1 Ll SO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: 0
:JY Phone No:
re
Integrator: P�]
Operator Certification Number: I coa
Back-up Certification Number:
0 " Longitude: ❑ ° =
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharees & 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?
Cattle
Design Current
Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEX Caw
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures;.
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes $kNo ❑ NA ❑ NE
❑ Yes ❑ No RNA
❑ NE
❑ Yes ❑ No �1A
❑ NE
❑ Yes ❑ No WrNA
❑ NE
❑ Yes AtNo ❑ NA
❑ NE
❑ YesNo ❑ NA El
12128104 Continued

2
Facility NoAiber: q3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tyNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
kNo
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
0No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
)allo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
)�D No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ii No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Z] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F 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):
AL
T
Reviewer/Inspector Name s E NTH Phone: [phone]
Reviewer/Inspector Signature: Dater }
12128104 Condnued

s
Facility Number: 413 —O Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W+ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
t%,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
19,NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No-
❑ NA
❑,NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
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
[P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
14poe- r Vv-,:s ; n4a_i ld o. QQ-r r �
U'l GIs . ?u4 ; Set u ► ce.
Mans --a install Cove-rs on 6tk cAns
12128104

�1
Facil'ity No. —� Time In %c�(D Time Out Date 3I
Farm Name RiG J(__ Eai Yv\- __ _ _ Integrator P&
Owner 1� q(6�� Site Rep �.,� `i_]�� ��-�
Operator L No. _
Back-up No. -
COC Circle: General or NPDES
r
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
ish
Farrow - Finish
Feed - Finish
Gilts 1 Boars
Farro - 7 can
Others
FREEBOARD: Design
Sludge Survey O-?
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Observed rr --
Calibration/GPM 0 YOl
Waste Transfers a r
Rain Breaker =—
PLAT =; "
Weekly Freeboard y Rainfall 1-in Inspections
Spray/Freeboard Drop r'0"' 70
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Date Nitrogen N)
Pull/Field Soil Crop Pan Window
- C) C-(
0-v
C. v ✓

(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
(Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Q1Other © Denied Access
Facility Number 3 Date of Visit: 9 0 Time: = od
Not erational O Below Threshold
© Permitted 13 Certified�``� __13 Conditionally Certified 13 Registered Date -Last Operated or Above Threshold: ................ _.......
FarmName: ............_.. ... r!^..... ................ ............ ....... .......... County: „...........» 1.116rAUIV7
OwnerName: ...... „»............................... »......„ —------ ------ „.... „.._..._... ».. »........».. 'Phone No: „.„............. » ..».» ...._» ... . _.......... »..__ .._....
MailingAddress:...__... _.__........._._ » .._ .. �_ ....._...»._»......_.... ._ ..».__».. » ..._.»_..» ... __ »...» .... »»..».... ...» .. _ ... .
Facility Contact:
Title:
Onsite Representative: ............ .. „ _.... , »,».. _._„...__._.„.„ .. ,.. Integrator:
Certified Operator:
Location of Farm:
Phone No:
»,,.» »..»» ».„..,,».».»........ »»»»...._... Operator Certification Number:._..._...»..»__. »._.......
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & " Longitude • ' «
�••^,-•��. '. .--
_.�.ii iL4i�: :.1�.V
YYiYVY.'j
S^..---vw �:'li:;'. RWi �ca.V YlYYVY�
Wean to Feeder
❑Layer
Feeder to Finish
❑ Non -Layer
::...:. . .::. ..... ... . .
Farrow to Wean
Farrow to Feeder
Other
Farrow to Finish
1
Q Gilts
Boars
�I�Afl �i�tt rt� I� f
Rnldie4i
Discharges & ,S Impacts
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?
"aci Po 'Watioii''
y ❑ Dairy
h ❑ Non -Dairy
I,
�1
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idendfier:
Freeboard (inches): Zi
12.112103 Continued

Fa " ity Nuber: Af 2 — v( Date of Inspection
r
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenanceCimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [:]No
elevation markings?
Waste „Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

fVisit � Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
n for Visit Q Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
�/�j
Date of Visit: � Arrival Time: � {� Departure Time: � County: e-11 Region: Lbw
I���
Farm Name: ��--)
Owner Email:
Owner Name: ff rr,, l n J }� Phone: 1� r �Ux�
MailingAddress: 4urly �-knkAZl Nad 1�-�!. 6unn u � V C,
Physical Address: (�
Facility Contact: LD U QLU_ Title: l�tpr
Onsite Representative:
Certified Operator: L 0 8Ic".dQ' __
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 0 0 Longitude: = 0 0' 0
�esjgnurrent
Design
Current Design Current
Swine
Capacity
Population Wet Poultry Capacity
Population Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
1 10 Non -Layer
Feeder to Finish
Farrow to Wean
r2loow
(0 V771
Dry Poultry
❑ Layers----
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Finish
Discharges &Stream Impacts
L
1. Is any discharge observed from any part of the operation?
❑Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
❑Yes
❑ No
MiNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
UN 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
MNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
�JJVo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
'KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number:45
Date of inspection U 7
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): r
Observed Freeboard (in): 1:2 [p
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 Z No ❑,, NA ❑ NE
El Yes El No MNA ❑ NE
Structure 5 Structure 6
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes 0 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 14 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markcrs as required by the permit? ❑ Yes &I 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 1kNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 14 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A*No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
1XNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
PNo ❑ NA ❑ NE
❑ Yes RNo ❑ 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):
IReviewer/Inspector Name _ Phone:'i 10 4 53 ,5 I
Reviewer/Inspector Signature: Olu 1j` ,y`L ().,,.i Date: _7AI�A QkI �]",T
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Other
❑ Design El Maps
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
JkNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
n No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA "*XNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
�No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
0�pmr e.(cc feA 40 rc,- lU.rn 46
Page 3 of 3 12128104

4 r7
Facility No. `�"�'- Time In [ Time Out yDate
Farm Name �0.ur,—. �{�-if �� Integrator !' .���"1 4- t`
Owner Site Rep
Operator No.
Back-up No.
COC L1_/ Circle: General or
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow —Wean
Others
FREEBOARD: Design I I Observed
Sludge Survey �� Calibration/GPM 1
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test PLAT Wettable Acres �—
Weekly Freeboard r---~w Daily Rainfall 1-in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
3
M�a�
s�■
rt

12111i
_r,Dlvisio otd So[nWatee Coitservtii•FFi .2 ,j it ^�"•- �i F�. //�� r?'Si4"'.� rki'F ... 'x s;l` 'i � - u ,i.d r i? -. - ,� - .. ,
eaC � � I e t �� j 3� ri r ..c i3•� u..t.�: "n to y. ',.'t;
r,��+tpk'
`+i aif.i. "f�.vF�'`k;�•�-i.0''!��.i.i:s..i''451:HtEs,?iP'..)3 a�`..i7 +.[.,T• .... .. �8: - t , E:r'S au �'. _ - �.. �:. �,I.�. a:... .tz •..:,A/,— t0 ..». i.
Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine C) Complaint 0 Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number Hate of Visit: Time:
Not Operational 0 Below Thres old
® Permitted ® Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: R(C_C_ L� �—car,..._ County:
Owner Name: Phone No: e1 i 0 I u- 2S aid
Mailing Address: _l` �.� D Le.w.iA e( R I C.dc_ el �+��r._L���.l � . C, AR32 3
Facility Contact: Title: Phone No:
OnsiteRepresentative: __j_s 1 AlruL ___ Integrator: Pjar- S�P�[1D
Certified Operator: , L 1, ._ _ Jj1 «LL. Operator Certification Number: ] Zr 2.4
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ° I�u Longitude 0 1 46
Design Current
Swine C ananifv Pnnnlatinn
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acltv Po ulation Cattle Ca acity Po elation
❑ Laver I I ❑ Dairy
❑ Non -Laver I 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ;I Subsurface Drains Present ❑ La oon Area Spray Field Area
'MoldingPonds 1 Solid Traps fLiquid
p t . No Waste System
Discharges &: Stream Impacts
1. is any discharge observed from any pan of the operation? ❑ Yes [3No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed• what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes FUNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 5 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway M+00, id-eol­ #a ❑ Yes MNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 7 a
Freeboard (inches): 31
05103101 Continued

Facility Number: 4,3 — 4 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
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 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
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 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
El Yes
� No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
rNo
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
MNo
Required ReEords &documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes tRNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes L SNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freehoard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Le
No
24. Does facility require a follow-up visit by same agency? ❑ Yes r%No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ti
mmentsquestion#) EnplalnxriyYEStanswers:and/orauyrecrmmendatlons ur4any other cariments.e''drawings of facility to bMter explelrinsltuatfons: (use additlontt]!pages ae necessary) _ `, [] Field Co s
pv ❑ Final Note
�4nS rz.4�cdl WCaxa� Cl tin Q CA'D bad � � �A ka,r k>1
artfYa� gym. i I
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05103101
Continued

Facility Number: 4J — Date of Inspection 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hohrs?
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 ® No
❑ Yes ® No
❑ Yes [!�,No
❑ Yes ❑ No

State of North Carolina
Department of Environment,
` Health and Natural Resources • •.
Fayetteville Regional Office
James B. Hunt, Jr., Governor � C
Jonathan B. Howes, Secretary C
Andrew McCall, Reglonal Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 29, 1995
Mr. L. D. Black
L.D. Black Farms
Rt. 1, Box 186C
Bunnlevel, NC 28323
SUBJECT: Compliance Inspection
Harnett County
Dear Mr. Black:
On August 1, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility is
In compliance with 15A NCAC 2H, Part .0217, and that Animal Waste Management is being
properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
D.T. Jones
Chemist
DTJAs
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

DIVISION OF ENVIRONMENTAL MANAGEMENT
L—, f), rfig/W s
SUBJECT: Compliance Inspection
County
Dear
On , ,san! inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this facility is in compliance with ISA NCAC 2H, Part .0217, and
that Animal waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
P,rj
6/.
Enclosure
cc: Facility Compliance Group
Sincerely,
0. j,
Gra o son
b nmenta-l--Engineer

Site Requires Immediate Attention: _
Facility No. y3 _
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: L-' P-
Mailing Address: 40
County:
Integrator: 's
On Site Representative:_
Physical Address/Location:
DATE: , 1995
Time:
Phone:
_ Phone:
E
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site v�
DEM Certification Number: ACE' DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 5 year 24 hour storm event
(approximately 1 Foot + 7 inches) Os or No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? a or No
Crop(s) being utilized:_ .�
Actual Freeboard:�Ft. Inches
Yes or U Was any erosion observed? Yes or(go
o
Is the cover crop a equate? Yle or No
Does the facility meet SCS minimum setback criteria?' 200 Feet from Dwellings? n or No
100 Feet from Wells?&Sor&
or Nb
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(9
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other ,
similar man-made devices? Yes or N If Yes, Please Explain.
Does the facility maintain adequate was management reco (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop: or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTE CAROLINA a1PARTMWT OF ENVIROKkZNT, HEALTH A WATMUL USOMCSS
DMSION OF ENMON'HEMAL MAMAGEMiEi+]T
Fayetteville Regional Office
Animal operation Compliance Inspection Form
��a:�a :� , :i;f�%i �.;v%n,�•�,'..bo.'.;a,, �'•�'M`^ ,�w�
,.:f. Yr�� ..3':' ��y� w�•, .<:��:.ry: �.y.:: ,;..:
Jr`.
^6RR'1 x
gn:w v:;.w:5.:r$i`�'�?�•.-`ii::: Nr�.Y .. ���r.
y�,••�T/�►�� 7�� >:aM. �p ����p �v �„::
':Lw, �y,c•y�iiiliaiaay µair«;
•"+'A'�:::�= :.0 .,!�;
::� �L4i iVi\`��ii.:�'�
LD nfack -7]T
i Mrn
Y, n�`4 Y'^' W ..Y,r � w'r. •F.:.. i'M:... n.rJ wrr .
I-j I fox I&OC, BLt-i,)Y)[,eve1, �J&)-VA3
C?10 -093-252-s 0 712f Wa rs
All questions answered negatively will be discussed in sufficient detail in
the•Comments Section to enable the deemed 8ermittee to perform the appropriate
corrections:
SECTION I
Animal Operation : Feak!' +o -ani Sit
Horses, cattle, swine poultry, or sheep
SECTION ,II
X I N I COMMENTS
1, floes the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
system) )
2. Does this facility meet criteria for
Animal operation RECXS' ATLW.
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. noes this facility have a CERTIFIEa _l1NTL,
WASTZ wW GZKE rr PLC?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
b. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?

&ECTION Ill
YI N
I'ie d Site Management
1. rs animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Slue Line Stream?
2. is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. boas this facility have adequate acreage
on which to apply the waste?
4. Does the land application'site have a
cover crop in accordanee'with the
MT,IYIChTIQff
5. Is animal waste discharged into waters of
the state by mats -made ditch, flushing system,
or other similar mats -made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved MTTF,CATIQII?
7. Does animal waste lagoon have sufficient
freeboard? How much? {Approximately )
8. Is the general condition of this CA O facility,
including management and operation,
satisfactory?
SLG"PZCN IV
Ga

ti LD BLACK
TAKE 421 NORTH TO LILLINGTON
TAKE A left ON NE 210 GO
11.0 MILES, TAKE RIGHT ON
RR 2064 GO ,4 MILES TURN
RIGHT ON 1125 GO 1.8 MILES
TAKE A RIGHT ON RR 1126 GO
.7 MILES FARM IS ON THE
RIGHT.
A n •1'+if •. 4.
. . . . . . . . . . . . . .
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b

?.EGIS=?ATIDN ECRM : CR A.NILMAL Mz:LCT C?r?-A7:ON5
Department of Environment, Healc.h and Natural Resources
Division of E.: v_rarmental Management
Water Quality Section
if the animal waste :management system for your feedlot caerati,on
is
designed to serve more zaan or
equal to ! 00 head
of cattle,
75
horses, 250 swine, :, 000 sheep, or 30,000 birds that
are ser•."ed
by
a _icuit waste system, t :e_^. t:^_s
form must be =ii_ed
cut and :nailed
by Decemter 31; ' 9933 pursuant to
_5A NC" 2::.02;7 (c)
'_: arse; to
be
deemed permitted by 6F-M. ?,ease
?rz.^.t clearly.
m rm Name:
Ma-__^c Address.
Counc :
Owner (s) Name: e
Manager (v Nacre:
Lessee Name:
.arm Location (Be as specific as ossib, Load names, dir0ctlen,
mi+eoost, etc ) cl M -; ra+-
/G� V e-.5
< e kT: I 1 11 c- 0, r, i . rn r c -i m 1, C vi Q .kc hl. .,, —
Lacit:de/Longitude if known: -
Design capacity a= animal waste management system (Number and type
cf confined an:. a_ (s) )
Average animal popu' tiara on the farm R mber and type of an'_mal (s)
1i
-raised) l a.
Yea_ Production Began: /`, ASCS Tract No.:
Type of Waste Management System Used: dN
U
Acres Available for Land Ap _ic i�n f Waste:
Owner (s) Signature (s) DATE:
DATE: