430013_INSPECTIONS_20171231

NORTH CAROLIN
Department of Environmental Qual

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Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! Departure Time: County- ne T'r Region: /0,V
v Farm Name: , /k 2 Owner Email:
' Owner Name: ti%p'p Phone:
Mailing Address:
Physical Address: �-�] 1
Facility Contact: I .04' as jwo "le Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
u
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: �� !Z ! •
Certification Number:
Longitude:
Design Current
Swine Capacity Po'p.
Design 3„ Curre©t
Wet Poultry Capacity Popp
Design Current
CattleICapacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Feeder to Finish
Non -La er
Dairy Calf
Dairy Heifer
Design Current : °'
D`. P�oult�. Ca sac' P,o
Farrow to Wean
Farrow to Feeder
1-
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
r E
f
Other
Other
Pullets
Turke s
Turke Puuets
Beef Brood Cow
z
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DW R)
Z. 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 1P No ❑ NA ❑ NE
❑ Yes
❑ No
V NA
❑ NE
❑ Yes
❑ No
(P NA
❑ NE
❑ Yes
❑ No
Vq NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:}
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3 22'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Vg 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 C� 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 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 10 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IF
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V No ❑ NA
❑ 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 Approved Area
12_ Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the
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?
❑ Yes �] No
❑ Yes R2 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
R uired Records & Documents
19. Did the facility fail to have the 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 ves, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. T
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [jj�No
❑ Waste Application ❑ Weekiy Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility faii to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes P No
[:]Yes CP No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[]NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/412015 Continued

I
Facility Number: Lf A - 1 ";t I (Date of lnsaection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F�j No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[9 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
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Qa No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
❑ Yes [�j No ❑ NA [] NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes [$tNo ❑ NA ❑ NE
❑ Yes [N No
[:]Yes Ejj No
❑ NA ❑ NE
❑NA ❑NE
Za
21412015

type of visit: W uompuance inspection LJ vperanon meview V structure r vamanon %j ieconrcai Assistance
Reason for Visit: ID Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
ime• County: %j'"AR�Region: /<go
Owner Email:
Phone:
Physical Address: `-'Y 1 , -) 4or4
Facility Contact: i ojya5 W " Title: Phone:
Onsite Representative: l Integrator:
' ` �72g9
Certified Operator: Certification Number: .
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Capacity Pop.
Z
Wet Poultry
Layer
Non -La er
D , P,R
Layers
Design
Capacity
maesign
Ga aci
Current
Pop.
Current
P,o
Design Current
Cattle Capacity Pog.
Dairy Cow
Dairy Calf
Dairy Heifer
Cow
Non-Daity
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Pullets
Turke s
Turke Pouets
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes ❑ No
[:]Yes [a,No
❑ Yes M No
NA ❑ NE
T❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

FWIfli Number: 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? 9No [� NA NE
❑ Yes /" ❑
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: S6 — -q 2
Spillway?:
Designed Freeboard (in):
6r
Observed Freeboard (in):Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EpNo ❑ 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 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
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil.
❑ Outside of Acceptable CFop Window ❑ Evidence of Wind Drift ❑ �pplicQtion Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in
CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ Yes
❑ Yes
No
No
No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
D Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Trsfers
❑ 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 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes��o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

wiv umber: Date of Ins ection: ZO Ifo
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
'a No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
KNo
❑ 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
01
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes}
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
[!p 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
[�PNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M No
❑ NA
❑ NE
Comments (refer_ -+to question ft Explainany.;YE&answers'and/or any additional recommendal;ions any other comments. 1
Use drawitts of facility to better explain situations (use additional`"pales as necessary): �` Y..`'
,
_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /D /l � �7✓d�
Date: ZO /
Z14/2 1 5
0

49
Type of Visit: W Compliance Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ` y�� Departure Time: b ` County: f� Region:
Farm Name: &V0,01 t'S 6t3GC`S J'> �6 S � Z Owner Email:
�f �rP
Owner Name: Wrn � CbPhone:
Mailing Address:
Physical Address:
Facility Contact: _ ,q j% U10 Title: Phone:
Onsite Representative: W Integrator: / 't tlr
N
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current - Design Current
Swine =Capacity ; Pop. Wet Poultry Capacity Pop.
Design Current
Cattle C14
apacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
_
"1jesi
D . jPoW , ,tom Ca aci P._ti
Dairy Heifer
Farrow to Weans
Dry Cow
Farrow to Feeder
y2.00
Non -Dairy
F'brow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Turkeys
TurkeyPoints
Beef Brood Cow
Other:*'
OtheW.
r
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 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 P No ❑ NA 6 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
21412014 Continued

Facility Number: jDate of Inspection:
5—
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): 9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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 ® 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 ONO ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes f5No ❑ 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 J ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cagsj q , , C1µa J.� ©vte
13. Soil Type(s): II 09 1 4 �r/��T I ✓lap, A"
. the I� SP
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1p No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
;0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
8 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the 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 appropriate box.
❑WLIP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
(] No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stacking ❑ 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
®i No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

�1
IFaciUtyNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes PO / 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? ❑ Yes FM i No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No
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?
Comments (refer to question # ): Explain -any: YES answers and/or any additional=recommends
Use drawings of facility to better egpWn situations (use additional "pages as necessary} x
1/6
�r � i�rSr� Coy.-�p�ee�� ���/� o9<'�aF,..—�D.'3�Q�.•
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Pg No ❑ NA ❑ NE
❑ Yes [�a No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �g No ❑ NA ❑ NE
❑ Yes �j No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: '%1 a Y I 3V
Date: I
21412014

Type of Visit: lj�TComp lance 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 0 Denied Access
an
Date of Visit: Arrival Time: �!2- Departure Time: County: AV144'_1Region: FA
Farm Name:r. �� L-0PE Owner Email:
Owner Name: �byui-a-�� w0 4f Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
r �/1DigL�S tA/V44fofe Title:
fit
Phone:
�}
Integrator: 1 �iY,J
Certification Number: 90`P' /
r
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder I
INon-Layer
I
Dai Calf
Feeder to Finish
"°`` _y
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
I) . P,oul
Ca acI
P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
:
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ETNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
[fr NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
[TDNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
ErNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
ErNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facili Number: - Date of Inspection: AVrl,r,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
t[Xo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3-NX— ❑ 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
❑ NA
❑ NE
waste management or closure plan?
r�
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
[]
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2'N-o—
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes D 1Vo ❑ 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): Nw dtzne,CG
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. 1s there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents 10-
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ 1i° ❑ 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 E to ❑ 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 [R No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility N mber: - Date of Inspection: atl
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes <o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cg-N6__ ❑ 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?
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)
❑ Yes
0� o
❑ NA
❑ NE
❑ Yes
[2-5o
❑ NA
❑ NE
❑ Yes I3 <o ❑ NA ❑ NE
❑ Yes O NNo ❑ NA ❑ NE
❑ Yes [f No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
[209'
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;T&o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question #i): Explain any YES answers and/or>any additional recommendations,;_©many`other comments.
V
Use,drawings`of,facility 6 better explain situations (use additional pages as necessary.).
at-L�„i,�,
61J H "y �e+� ,V S�bPeS �fr<
4t7L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pholfo_q33-33
Date: `
21412011

Type of Visit: ©'Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: OrCutine O Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: I U Arrival Time: Departure Time:. County: a/Jl Region:
Farm Name: G a-li` V-0 6 11 t M n ") ZY\ Gt Owner Email:
Owner Name: t r�oyy l'C' Phone:
Mailing Address:
Physical Address:
Facility Contact: �1"� t ti Title: �� Phone:
Onsite Representative: Integrator: M 9
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
DesignCur�ent � . Design Current
Swine Capacity Pap.
Wet�Poultry
Capactty�Pop °s `Cattle Capacity Pap.
nish
We11oFeeder
La er
DairyCow
Wean
Non -La er
Dai Calf
Feedeinish
, Dai Heifer
FarroWean
ignCurrenD Cow
FarroFeeder
D . P,outt ,
Ca ace �Po x - Non-DairyFarroFinish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
rs
Pullets
Turkeys
Beef Brood Cow
_
er
kOther
Turke Poults
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
[E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
ONO
B'NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes
❑ No
[E'NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
ff fNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[?f No
❑ NA
0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

):acili Number: -En Date of Inspection:
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
[y'�io
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
U.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E 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
[g'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
E2--No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. -Does any part of the waste management system other than the waste structures require
❑ Yes
[Ef No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ "No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): jG�
13. Soil Type(s): i�[�h►'4 1 "fix g f GNn j VGC FiI f (t-S L
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EE�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
19�<o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EgNo
❑ 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
[EI-No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�To
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[i;Ao
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!TNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 5' No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes t0 o
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?
Reviewer/Inspector Name:
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ff a No ❑ NA ❑ NE
❑ Yes �io [DNA ❑ NE
❑ Yes [a Vo ❑ NA ❑ NE
❑ Yes [y]"No ❑ NA ❑ NE
❑ Yes
�o
❑ Yes
[DNo
❑ Yes
E9 o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: U 66
21412011

Type of Visit: VCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Or"Routine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �r^ Departure Time: QS�,�f County: 'IAMill z.-4 Region: r IR0
Farm Name: p� (1 R 01 \ `5 l pc) Q NC-. i _ Owner Email:
Owner Name: F n R(3_. Phone:
Mailing Address:
Physical Address:
Facility Contact: ` T h6tn A 5 U ca m b O —Title: 0 ►.> nrR _ Phone:
Onsite Representative: q Integrator: M utip�g
Certified Operator: 'T IhUrn A 5 CALMIpp— Certification Number: Q $ 7 aLl'q
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design Current
Design Current
Swine Ca aci "
P ty
.,1 Po P•
Wet 1?oult , Ca aci Po
i7 P h P-
Cattle Ca aci Po
P h' P•
Wean to Finish
JLayer
Dairy Cow
Wean to Feeder
Feeder to Finish
Non -La er
I
Dairy Calf
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. PoW Ca aci Po P.
Non -Dairy
Farrow to Finish
Gilts
Layers
Beef Stocker
Non -Layers
Beef Feeder
Boars Pullets
Turke s
Beef Brood Cow
Other 'Turkey Poults
Other 17i0ther
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 NfNo ❑ NA ❑ NE
❑ Yes
❑ No
[i"NA
❑ NE
❑ Yes
❑ No
[2 NA
❑ NE
[:]Yes ❑ No
[:]Yes [2�No
❑ Yes [3*No
[dNA
❑ NE
❑NA
❑NE
❑NA
❑NE
Page I of 3 21412011 Continued

Facility Number: - 3 Date of inspection: I 'a
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
Identifier:OR
Spillway?:
Designed Freeboard (in): yq C)
Observed Freeboard (in): 1 1;L�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
E�'<o' ❑ NA ❑ NE
❑ No [gAA ❑ NE
Structure 6
❑ Yes [2"No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
dNo
❑ 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
❑moo
❑ 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
[TNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E!fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [D/No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): VtN ULMU 0 1. ( HIII- -I , C,�a.ZEl S ,G•a -
❑ NE
13. Soil Type(s): _ iAf\E4 17'Ll. kJ`ARtoN clam. Z`RR&I 1-$1_!�\Ants O-6 .&IIAQ Q-1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [TNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes UNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [YNo ❑ 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 [�Vo ❑ NA ❑ NE
❑ Yes [R/ 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 [3"'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: q3 - I "S Date of Ins eetion: �$ j
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�fNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Q'1No
[DNA ❑ 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
dNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA 53 E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[V]�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
[glfio
❑ 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
YNo
❑ NA
❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9'*No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[!j`No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[tTNo
❑ NA
❑ NE
Comments {refer to question #}: Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings otLacelity to better explain situations (use additional pages as necessary).
�oo C) A fZ M
Reviewer/Inspector Name: _ ��\ q? , � EL'U g Phone: 7 jd - wd- (- fy
Reviewer/Inspector Signature: Date: S1 jQ't a
Page 3 of 3 21412011

Type of Visit: I2rCompliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 04001ine O Complaint 0 Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time o Departure Time: i� County: Region:
Farm Name: Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: lynGt-S Title: �[A Je r— Phone:
Onsite Representative: Alba 1Z , Integrator: Aad
Certified Operator: S (j,�„ __ Certification Number: i
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
r �w
Design Cur err at, `, Desi Current .
Design Current
Swine 6
p
Capacity Pop.:WetPoult Ca act Po
.t
Cattle` Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
APE
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design C_urrenf
Dry Cow
Farrow to FeederD
ult • Ca ae�ty�P;o P.
Non -Dairy
Farrow to Finish
Layers r,
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
'•y4
O#her
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes To ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes
❑ No
IJ "'H
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) [:]Yes
❑ No
Il l 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❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes To ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes QXo' ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 02-<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No fJ 1A ❑ NE
Struc e l Structure Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
_ �
Spillway?.
Designed Freeboard (in): - / 9 —
Observed Freeboard (in):� .3 �,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
e 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
M10
❑ 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
To
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2 oo
❑ 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
ga o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g-<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
U2,115
❑ 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 rift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): -LiDw 4A&_
14. Do the receiving crops differ from those designated in the WMP?
❑ Yes
K o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ga-]Qo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
IJ <o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
021 To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
E3OKo
❑ NA
❑ NE
Required Records & Documents
/
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2-140
❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
g3l<o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
@<o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
0 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
Q-No'
❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
A ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 73 Date of Inspection: lJ '7 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? / ❑ Yes [E�l < ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes Ug-?1 ❑ 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 ❑ No ❑ NA
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
H31 o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E315o"'
❑ 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
E+1 o
❑ 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
I ETKo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ga oo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
NA ❑ NE
mends Mons or
Comments (refer to q_ #): P y. y r any otherycomments
Use drawings of facility to better explain`situahons (n a additio aE pagesas necessary).
_. . _a
l
Reviewer/Inspector N
Reviewer/Inspector Si
Page 3 of 3
Phone: �.
Date: Q
4/20 1

Type of Visit 4W Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit lb Routine O Complaint O Follow up O Referral O Emergency O Other ❑Denied Access
Date of Visit: Arrival Time: Departure Time: r Q/h County: `' Region: 9:K9^
Farm Name: Z 61(_�1 S Rcds Owner Email:
Owner Name: T a. wor"1 f Phone:
Mailing Address:
Physical Address:
Facility Contact: 00MO 5 rn wQ1' G k- Title: Phone No:
ti
Onsite Representative: Integrator: ac
u aCertified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` ="
Longitude: = 0 = I = "
Swine
Design Current
Capacity Population
Design Current
Wet Paultr�y Capacity Popnlation
❑ Layer
❑ Non -Layer
Design Current
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
Dry Poultry
❑ D Cow
❑ Layers
❑ Non -Dairy
❑ Non -Layers
❑ Beef Stocker
❑Beef Feeder
❑ Pullets
❑ Beef Brood Cowl
❑ Turke s
Qther
Turke PouItser Other
FOR
Number of Structures:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
ZZoo
?Zf�
Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
P-No
[INA
ElNE
Discharge originated at: El structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
Lf--rNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El yes
❑ No
PNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (1f yes, notify DWQ)
❑Yes
❑ No
tONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
[$3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
§Q No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2/.28/04
Continued

Facility Number:q�L13Date of Inspection 7 d
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
CU NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: Urb
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?j ! V tr
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;!TNo
❑ 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
2PNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 12PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D1 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) & �q L/ " , 16ST1--p - 1 *,, - G` � ,
13. Soil type(s) (j h
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
El
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
No
❑ NA
❑ NE
Reviewer/Inspector Name V"� tj 1:� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of f 12128104 Continued

f �
w'
Facility Number: — Date of Inspection 'r /0
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 ❑ 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 ❑ 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 T No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[B No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;kNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
$ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerhnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I$ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�9No
❑ NA
❑ NE
Page 3 of 3 12128104

aDivision of Water Quality
Facility Number Q01 0 DiAsion of Soil and Water Conservation
_- -.. __ _ _ __ - 0 Other Agency�3
RZ
Type of Visit Gt Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 5j A� Departure Time: ,`{i �� County: /jt Region: �r(1
Farm Name: r' �lD } Lll/rlD�9 Owner Email:
Owner Name: WCo,-V Phone:
Mailing Address:
Physical Address:
Facility Contact: ` hdS' tV �'1.�7 i� Title: Phone No:°�1
It
qD- 01 o C
Onsite Representative 1-�10,� 1N +h� Integrator: Pl-f& zol'r}()
Certified Operator: I � WOM bile Operator Certification Number: 4VA c87@ &
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = c =' Longitude: = ° = I = u
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
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp-es & 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 Cui
Cattle Capacity PoM.pu
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
E]Dry
Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
GrNo
❑ NA
❑ NE
12128104 Continued

I.FacilitX Number: 93 —()
Date of Inspection M—U—__1
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?
❑ NA ❑ NE
El NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):(� _ 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ERNo ❑ 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?
❑ Yes UNo
❑ Yes ❑ No
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 CR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes No El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [SNo ❑ 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) CO ! Cm Id/2-
13. Soil type(s) 'D)&hqw�S r r 5 r v
14_ Do the receiving cr ps differ from those designated in the CAWMP? ❑ Yes ENo ❑ 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 RNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [RNo ❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes ® No ❑ NA ❑ NE
Reviewer/Inspector Name S CWt7l Phone: ILVO) 'M -�=
Reviewer/Inspector Signature: Date: 'aona PLct—
Page 2 of 3 12129104 Continued

Facility Nu m'ber:`43 —Q Date of Inspection W
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes E?No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
UYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 'R 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes 5 No
❑ NA
❑ NE
❑ YesNo
CRNA
❑ NE
❑ Yes bd No
❑ NA
❑ NE
❑ Yes ® No
❑ NA
❑ NE
❑ Yes jffNo
❑ NA
❑ NE
❑ YesS&No
tKNA
❑ NE
❑ Yes BNo ❑ NA ❑ NE
❑ Yes
�3No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
a I, Orl e_ W6* 4 4'�41,0 M�n5S, �e- hi PAN Ivor v4 far- sfi, Qob- ��
PAN hor not v's, e elaw 40 imp *501
4( a,17 f0l. Anal I � ad
xev wOr Ire b a caps
vvork„ wor ar , l-4'1ViV 0003 o Plebe o s !� � s�� ; �mR��`t�E'�
4moll recos`°
gas btet,- 5+ S'�; 4e. -7 r y
mil �e A/C a1, 30 1, Soil rept' d � refry t R�,�r Ra IP j J� »'�Gr C
c oe, _W /
i, Owner w 1� 9e-�o„ �►y�►lv�-�rfj on baCksfofe (?a 1/),@04"7.
15, CV04 t TOrlke i n Nov DOW � � A
12129104

.Facility No. +3- 13 Farm Name Date
Permit COC OIC v NPDES (Rainbreaker PLAT Annual Cert)
Pop. Type Design Current 9 F8 Dro s
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
7
1 o
Sludge Survey Date I --f'
Sludge Depth ft & %
3.
o�
Liquid Trt. Zone ft
-tn ►,n ta-f I d- Y l..&Pe►a % . , Pr wh% 1Y es, _
r4ri
C'
7-caribration Date
Design Flow
Design Width
i�3i1�1 •---' Soil Test Date Crop Yield 1 in Ins ✓ pections
pH Fields 120 min Inspections ✓
Wettable Acres ✓
Lime Needed .�. Weather Codes
Lime Applied L?,Uy11'Dt/ ✓ WUP Transfer Sheets
Cu ,% Zn ✓ Weekly Freeboard % RAIN GAUGE
Needs P Rainfall >1"
mI� �'rF' �1���_Iy4�rV.�i�'r7�H7fB►h'�L�/ll'�.h'�•rl
Waste-Knaly�
• 1X _
r
Pull/Field Soil Crop RYE PAN Window Max RVu-
((e r o7,-t-
I or
73-
Verify PHONE NUMBERS and affiliations
Date last WUP FRO tj Ia00L( Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

5
A -
0
--- I T

r Division of Water Quality
Facility Number 3 O Division of Soil and Water Conservation :1 0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time:
Farm Name: l -r LLB 11 j i oo7 s I eK FLrm 0 v q Z
Owner Name: L Co r-12
Mailing Address:
County:
Owner Email:
Phone:
Region: FAEO
Physical Address:�j1 _ Facility Contact: NV i 1 f e Title: `� Wk1Q ✓ Phone No:
Onsite Representative S Integrator: I'r)L'rA9
Certified Operator: , _ Q'LG S, Operator Certification Num
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 4 = u Longitude: = o Q & =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
II JEJ Non -La et
Dry Poultry
❑ Layers
❑ Non —Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 P No ❑ NA ❑ NE
❑ Yes
❑ No
R(NA
❑ NE
❑ Yes
❑ No
[�,NA
❑ NE
RNA
❑ NE
❑ Yes
❑ No
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
5.�q^io
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 2 I O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ANo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: Cj. Z
Spillway?:
+
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�Uo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
4No ❑ 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
[k No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
5(No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IgNo ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence�� of Wind Drift ❑ Application Outside
of Area
12. Crop type//%i
s) tJ2►'i''�'1 ud-IX H/1P . S7 C-1 /' d 's
13. Soil type(s)
14. Do the receiving crops differ tWn those designated in the CAWMP?
❑ Yes
C3 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
&I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CQ 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):
- I 2 �
Reviewer/Inspector Name S & A Phone: 10 Soo
Reviewer/Inspector Signature: Date: e� 27 65e
1_11251!4 Lontinuea

Facility Number: — Date of Inspection /!
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [UNo ❑ 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 R1 No ❑ 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
NJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
,MNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P�-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
CiLNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1P 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
El
El 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
PjNo
❑ 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
jNo
❑ NA
❑ NE
Additional Comments and/or Drawings: r /
Ste- crtcAa- e Fo-11 ©1 R_ t w► k +ke- CA[: j«4-ta4 raf*5
00,49 aral S, r. Va . 0 -
Q-04 *. n lu-z f a t,_�Zr k_ an �r05
S-6" d 07VI 12_C 11 . ca h Ck w'
boar e SCU45 . (j
12128104

Facility No. 3 — `Z Time In Z� Time Out Date z �r
Farm Name R l [rain Rio n� r'arti gas Ot Integrator
Owner Site Rep Q
//""
Operator _1 ce. _ _ No.
Back-up No. _
COC Circle: 6�eneral or NPDES
Design.
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean -- Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow —wean
Others
FREEBOARD: Design I C
Sludge Survey
Crop Yield
Rain Gauge
Soil Test � Wettable Acres
Weekly Freeboard � Daily Rainfall ✓
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
o is z-3 z•�
Observed qo
Calibration/GPM �- I _ Z�
Waste Transfers
Rain Breaker —
PLAT
1-in Inspections
Date Nitrogen (N)
Tg Z . 2- 1- 9
Pull/Field I Soil I Crop - 1 \ /Pan I Window
Lv t —
11
�,

W
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 1kRoutine O Complaint O Follow up O Referral O Emergency O Otper ❑ Denied Access
Date of Visit: ' 1 Arrival Time: `' Departure Time: [�7= County: Region:
t 1 G
Farm Name: r 0 S 1:C1� Owner Email
Owner Name: Phone: j�
Mailing Address: C W d Y15z1f1�4iY �1'l 1 �1
Physical Address:
+ t p�+
Facility Contact: iilSY�S-�[]iitl Q - Title: �X Phone Noq� Ib I`�_
Onsite Representative: integrator:
Certified Operator: r L�� `-�S�m Operator Certification Number: l
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o [--] ' E::] Longitude: = o = ' E] u
Design1-urient
Design Current
Design Current
Swine
Population Wet PouEtry
Capacity Population:
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑
Dairy Cow
❑ Wean to Feeder
❑Non-Layet
❑
❑
Dairy Calf
❑ Feeder to Finish
-
Dairy Heifer
❑ Farrow to Wean
,I)ryPiiultry
--
x' N`
❑
D Cow
El
Non -Dairy
,Farrow to Feeder
QL730 s
❑ Layers
El Farrow to Finish
El
Beef Stocker
❑ Gilts
❑ Non -Layers
❑
Beef Feeder
❑ Boars
El Pullets;
El
Beef Brood CoLAJ
--
❑ Turkeys
w s"_
Other
_ ❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
ElNA
ElNE
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made'?
❑ Yes
❑ No
[kNA
❑ NE
b_ Did the discharge reach waters of the State? (If yes. notify DWQ)
❑ Yes
❑ No
WA
❑ 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
[P 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
[-No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:-4 — d 1 S1 Date of Inspection
0 ' • l(
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?
Stcture I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): d e7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No 5VA ❑ NE
Structure 5 Structure 6
❑ Yes
)allo
❑ NA
❑ NE
❑ Yes
XKNo
❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require NA NE
maintenance or improvement? ❑Yes No ❑ ❑
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [INA ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ t om those designated in the CAWMP?
❑ Yes �dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Ad 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?
th-
❑ Yes )91 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facilrty to better explain situations. (use additional pages as necessary): 4
Reviewer/Inspector Name � N RJST — - .LA ITT6 M Phone:'l 10 y ,�A d� SOSO O
Reviewer/Inspector Signature: Date:, —.YAM 1% 2ji�0l
Page 2 of J 12129104 Continued

Faeility Number: Date of Inspection 1 O
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes lNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes '$CNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No El NA El 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 ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
IANA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
)qNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�KNo
❑ 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
[ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
;K]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
IRNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�] No
❑ NA
❑ NE
Additional CommeuEs and/or Drawings:
1JQ_ZrA 40 S+ �+r1 1 �-� - �- i�o Rxr1 S `
NegA 4z ve Ise_ Zoo( Cs�S{�- off �c��l NV_ Cote!S
�_ � nC zwt v C0.i • 6 i 0.4 zOd (,,, r
�QSS -C�r� ZaoS y 4re- re N O o[tartcci
.'kc' 1 q. i 411 e %i P_ 44 (Y e a 4tr n i . b
t �► � � cake - S �S-k' rY, ;►n5 �? C� •' o:r, .
lve-. C'^�r�&4 M) o 6CtiCL 5 o�-t q gL
C L
� ex, C J � SJf u tr �'7 3 Lv , `t vl J l' � Caf �f o �p �C/Yl
a r � ,r� � 1� r w4 t� vir
V Q >ru i t z a r irl . fX c 1 tv n rYlarr�
J
Page 3 of 3 12128104

Ct
JC>
0
\lr

FORM IRR-2
Hydran
s
Field Size (wetted acres) a
Farm Own
Owner's Addre
Owner's Phonr
Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Crop Type
(1) (2) (3) (4) (5) (6)
Facility Number
Irrigation Operator
Irrigation Operator's
Address
Operator's Phone fl
From Waste Utlilzatfon Plan
Recommended PAN
Loading (Iblacre) a (B)
(7) (8) (9) (40) (11)
•:TotalMinutes
Crop Cycle Totals
Owner's Signature
Certified Operator (Print)
Operator's Signature
Operator's Certification No.
• NCDA Waste Anayisis or Equivalent. At a minimum, waste analysis is required within 60 days of land application events.
Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each Irrigation event. 3114103
"'Enter nutrient source (le. Lagoon/Storage Pond ID, commerical fertilizer, dry litter, etc.)

r
Type of Visit iMompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ®'L'Zoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: , t7� Departure Time: ' County:
Farm Name: Co If 1`0) ).S f�bbnfr /i--nG, - �(� / Owner Email:
Owner Name: 77-11,1_. UAL"2 L_r Phone: _
Mailing Address:
Physical Address: // //%
Facility Contact: s9n�ss a 4 r- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
�� Region:
Phone No:
Integrator: z '5A C�
Operator Certification Number: ��+2 /
Back-up Certification Number:
Latitude: = e 0 0 Longitude: = a 0=
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish E
ERFarrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts 3
❑ Boars i
Other
❑ Other .
❑ La er
Ul Non -Layer I F==J
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current;.t
Cattle Capacity.... Population:
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ®r
- J
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 Vallo ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
IN No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
�RNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ZNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?: q*
Designed Freeboard (in): '-9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes K 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 r7 No ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R 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 Drill El Application Outside of Area
12. Crop type(s) C t1h it ok a- 1�ze Qe+ c sY _ G d �9 Y?'-
13. Soil type(s)
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[gNo
❑ 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
O 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
JR No
❑ NA
❑ NE
Reviewer/inspector Name REMMEWS-in L ` Phone:
Reviewertinspector Signature: Date:

Facility Number: Z7?j — 3 Date of Inspection
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 appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑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
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
DQ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
K No
❑ 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
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JANA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R 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
E&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
54No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(1No
❑ NA
❑ NE
12128104

_.— - . - , . " g
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
IReason for Visit lid Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
r_ Date oTVisit: S S Time: �: D
FaciGn� 'umber (,3
••— Not Operational 0 Below Threshold
® Permitted ® Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
i_
Farm \smc: ro { n Count•:
Owner Name: i kV yc[_ LioPhone No: q19 I Lqqn
Mailing Address: Mc ILo L4 ("u.'� _ /2Qcd G.y-v.S.LZr _ ,V_L,
Faciliry Contact: wvc✓a born _ Title: a.sv�eT' Phone No:
�7 wd r
Onsite Representative: ( !iM "N4,0 1 J d&�n 4 _ Integrator: ��+� Gj S
Certified Operator: 7,n v+n 6-'n t _ Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° " Longitude ' 1
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle . capacity Population
❑ Wean to Feeder ❑ Laver I JaDairy
❑ Feeder to Finish ❑ Non -Laver I I Jallon-Dain
❑ Farrow to '%Vean
IFFarrow tc Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / SoUd Traps
Dischars!es S Stream impacts
Subsurface Drains Present Il1J Lagoon Area IIJ 5uray Field Area
1. Is any discharge observed from any pan of the operation? ❑ yes ] No
Dischar2c originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is obsen•ed. did it reach Water of the State? (If yes, notif.• DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes ❑ No
2. Is tbrre evidence of past discharge from any part of the operation? ❑Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes UlNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � A
Freeboard (inches):-
05/03/01 Continued

i
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6was 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 MV 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 [ANo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [Llo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes q�No
12 _ Crop type acjM "_ d' 51� Vy- . (T . C> S ,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ER No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes qNo
16. Is there a lack of adequate waste application equipment? ❑ Yes (�*o
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[WNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
W No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CK No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
PNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
09vo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
E�:No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
4No
�] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,kd:.wF 'sas' -•_.4kaa- :. ----ya - '� a �aw�.,g: wr<�,,,. - a F�` ... ya;' wiivjl
Comments (referbto -f i,on #) Eicplaen anv YES%Kisyy' and/t+ r qy, rec©mmenilations or any other comments,
M.
Use drangs of facdtty [0 lyetter eiiplam sttuahons(useaaddrtioaal pages as necessary)
` l ; + Field Cony Final Notes
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: .2
05103101 C Continued

Facility Number: 43 — 3 bate of Inspection S o.
Odor ssu
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?
❑ Yes qNo
❑ Yes CR No
❑ Yes ® No
❑ Yes 2'No
❑ Yes No
❑ Yes No
❑ Yes No
05103101

State of NorthCarolina
Department Of- Environment,
Health and Natural Resources 4 • •
Fayetteville Regional Office
James B. Hunt, Jr., Governor � c
Jonathan B. Howes, Secretary G...
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 29, 1995
Central Carolina Pig Producers - Farm 86
Attn: Mr. Thomas
Rt. 2, Box 59B
Cameron, NC 28326
SUBJECT: Compliance inspection
Harnett County
Dear Mr. Thomas:
On August 2, 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,
\—U . Lk'(C.
r
D.T. Jones
Chemist
DTJ/bs
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville. North Carolina 28301-5M Telephone [phone] FAX [phone]
An Equal opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

C
Site Requires Immediate Attention:
• Facility No. A
DIVISION OF ENVIRONMENTAL MANAGEMENT3r��
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: (/
Mailing Address:
County:
Integrator: Aw�
On Site Representative:,
Physical Address/Location:
DATE: AG44•Y 1995
Time:
6G1-/ 17 LYA1
Phone:
Type of Operation: Swine Poultry Cattle ao v S�wS
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
W.
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of I Foot + 25 year 24 hour storm
(approximately 1 Foot + 7 inches) or No Actual Freeboard:_ 2 Ft. Inches
Was any seepage observed from the g n(s)? Yes or to Was any erosion ob ed? Yes or
Is adequate land available for spray? or No Is the ver cropad ate? �or No
Crop(s) being utilized: U A-L fpC n
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Imo%
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes 99
Is animal waste discharged into water 44e state by man-made ditch, flushing system, or other
similar man-made devices? Yes o N If Yes, Please Explain.
Does the facility maintain adequate waste management recoA(voiumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? a or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
event

it
NUMA CAROLMR& DWARMI`T OF ENVIRMEY7, EZs'. - & NATURAL RESCUr+G5
DIVISION 0? ENWRONTMIAL MAXAMMIMM :
Fayetteville Reg_cn l Office
Ani=al Operation Cc--pIiz=e Inspecrc_. ro=
...._. .......-PA.�Ii �RA?ft'_� .�-..---Y--�- • =�ii7S'�F.C�ION�;D9.."'S =w ,...`.:3�Ar.?i��NLTM�'E.� _..
M DRYS
.. _ - _ x� -� ,....t..�::• r:,.�-' -�..a �xcJS I'IY . T �-�oi�r wrEW
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All, questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Fernittee to perform the a_ propriata
correct_ons:
,SCTOlY I
imal Oceration Troy
EC_ ses, cattle, swine, poultry, or shaep
SCION II
Z. Does the number and type of aNal meet or exceed
the (.0217) Criteria? [Cattle (100 head),
horses (75), swine (250), aheep (1,000), and
Pcult-may (30,000 birds with liquid Waste
system)]
2. Dees this facility meet criteria far
Ani=al Operation REGISTRATION?
3. Are animals confined fed or maintained
La this facility far a 12-mcath period? .
4. Does this facility have a tE AN72u
WASTE Nam=mmTT PF.AN?
S. Does this facility maintain waste management
records (Volumes of manure, lam: applied,
EP=ay irrigated on specific ac=aage with
specific Cover Crop)?
6 : noes this facility meet the SC5 m' imu=
setback criteria for neighBc-0-- houses,
wells, etc?
Y I N I CO?4'MIMTIS
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NORT-H CAROLnU DZPARM4--= of EYYiia; ''t_, RZAL H & NA= —AL A_SOU-A=
Fayettev{_Ile Office
Animal operation Co--Pxiac :e Inspecticr. For_
-:Pater
•?S.tlI3.Z*iG-i1DDRV"'sw-;.t���=
.�
O e�
All questior.s answered negatively will be disc sed in su!ficie-nt 2etail in
the Coyne-nts Section to es:able the de&-=ed Fernittee to perforce the a_pro^_iate
corrections:
SECTION I
T_ral Onaraiian Tvoe: 12� � G �,&b �7-
-
te
Ec_ ses, cattle, swine, poultry, or sheep �:,#" ��
S2127I0N II
Y ! N 1 Ca?MMM"s
I. noes the numer and type of animal meet or exceed
the (.0217) criteria? ;Cattle (100 head),
horses (75) , swine (250), sheep (1, 000) , and
poultry (30,000 bi_-,d with liquid waste
system)] •
2. Does this facility meet criteria for
Anil pperation R=STRATTaq?
3. Are arsaals confined fed or maintained
in this facility for a 12--month period?
4. Does this facility have a C if ANIMAL
ASTE KIL-QkCZMENT PI.AI . S. Does this facility maintain waste manageren;
records (Volumes of ma=ure, land allied,
spray irrigated on specific acreage with
specific caves =zp)z
6. Does this facility meet the SCs miz-Ling
setsack criteria for neig:'�ar�r.g hcsses,
webs, etc?

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<cellent river and creek fishing may be
\yed,at Raven Rock State Park where
lassive, rock outcropping, 152 feet
juts out at a 451 angle over Cape
River.
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Farm Name/Owner:
Mailing Address:
Site Requires Immediate Attention:
Facility No.
��
DMSION OF ENVIRONMENTAL MANAGEMENT V3- l3
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: "v, 1995
Time:
Aou
! .s A+L- eho /" /A- f
<9 A "h,4 IVC a
�xw 9z
County: /-iArUc I _ . --
Integrator: L'dx& !1 Fob _n S Phone:
On Site Representative: AQ. ;r4amA-5 Phone:
Physical Address/Location: A4 !ELGy ??&*W 120AP ^ �� 5ul��s'�✓I'' aiy �5(yyy sy �!' ,-�c fsl`,
Type of Operation: Swine
Design Capacity:
DEM Certification Number:
Poultry Cattle
Number of Animals on Site: /?-00 So tills _
ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon ha sufficient freeboard of 1 Foot +,25 year 24 hour storm event
(approximately I Foot + 7 inches) or No Ac Freeboard:.S Ft. Inches
Was any seepage observed from the a (s). Yes or t' Was any erosion ob ed? Yes 00
Is adequate land available for spray? Uor No Is the -cover rop adequate? Y s or No
Crop(s) being utilized: C,09.5 4/ g'XMZ4 4-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? rc.�or No
100 Feet from Wells? 0 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or W
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orCD14
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management reco(volumes of manure,
spray irrigated on specific acreage with cover crop)? a or No
Additional Comments:
Inspector Name
Signature
land applied,
cc: Facility Assessment Unit Use Attachments if Needed.

ti
State of North Carolina'T T
Department of Environment,
Health and Natural Resources + •
Fayetteville Regional Office
James B. Hunt, Jr., Governor �
Jonathan B. Howes, Secretary FC
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 29, 1995
Central Carolina Pig Producers - Farm 86
Attn: Mr. Thomas
Rt. 2, Box 59B
Cameron, NC 28326
SUBJECT: Compliance Inspection
Harnett County
Dear Mr. Thomas:
On August 2, 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 21-1, 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)
48&1541.
Sincerely,
D.T. Jones
Chemist
DT J /bs
Enclosure
cc: Facility Compliance Group
Wachovita Building, Suite 714, FayetteWe, North Carolina 28301-5043 Telephone [phone] FAX [phone]
Ar Equal opportunity Affirmative Action Employer 50% recycled/ 1096 post -consumer paper

.P . `..
Site Requires Immediate Attention:
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address:
County -
Integrator:
On Site Representative:
Physical Address/Locat
DATE: AtAd'Y , 1995
Time; 11 41 2,3
�� dto
•u 7i
Phone:
Type of Operation: Swine Poultry Cattle 4 00 U foAo
Design Capacity: Number of Animals on Site:
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 + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized:
or No Actual Freeboard: 2 Yt. Inches
�n(s)? Yes or ti Was any erosion ob ed? Yes or 6d
or No Is the ;zver c_rop� L ate? Uor No
0k7-Y)-L tr�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings 65� or No
100 Feet from Wells? P or U0
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25.Feet of a USGS Map Blue Line: Yes or69
Is animal waste discharged into water 0s4e state by man-made ditch, flushing system, or other
similar man-made devices? Yes oz N If Yes, Please Explain.
Does the facility maintain adequate waste management recoft,(voiumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? a or No
Additional Comments:
P, t14NEf
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.