620003_INSPECTIONS_20171231

Division of Water Quality
Facility Number �. - © 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit: Q Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: , Arrival Time: s Departure Time: County:
Farm Name: / QCX5 Owner Email:
Owner Name: A6— flt �y1 s5 Phone:
Mailing Address:
Physical Address:
Facility Contact:
1 d QW Title:
Phone:
f
Onsite Representative: T U Integrator: _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
"Layer
Non -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouits
Other
Design Current
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes ❑ No
[:]Yes ❑No
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

6;
Division of Water Quality
FadUty Number © O Division of Soil and Water Conservation
O Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine' O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 'Arrival Time: Departure Time: County:
Farm Name: l r ve rs; 0l
Owner Email:
Owner Name: ��r �uT'��1 i Phone:
Mailing Address:
Physical Address:
Facility Contact: —rem 4/ 41 o D Title: Phone:
Onsite Representative: L" Integrator:
Certified Operator: Certification Number:
Back-up Operator.
Certification Number:
Location of Farm: Latitude: Longitude:
H1
Region:
x'4,1
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? ».
f
b. Did the discharge"reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[]Yes
❑No ❑ NA
❑ NE
2. Is there evidence f a past discharge from any part of the operation?
❑ Yes
❑ No ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No ❑ NA
❑ NE
of the State other than from a discharge?
s;
Page 1 of
2/412011 Continued
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T.q ; i' ._, s....
n;.. ..c .x . 761...;
•RA.FU'; :[. ....

Facility Number: - Date of Inspection: Z
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): 60 s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ❑ No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
❑ No
Waste Anulication
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ NA
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facifi Number: / , -�7 - Date of Inspection; 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
' Identifier:.
Spillway?:
❑ Yes
! Designed Freeboard (in):
❑ NA ❑ NE
Observed Freeboard (in): 2 r 60
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes ❑No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA
❑ NE
waste management or closure plan?
❑Other:
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA
❑ NE
maintenance or improvement?
22. Did the facility'fail to install and maintain a rain gauge?
Waste Application
❑ No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA
❑ NE
mainienance or improvement?
❑ No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No [DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility'fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA ❑ NE
E - Page 2 of 3
2/4/2011 Continued

[Facility Number: 7,, 7 - Date of Ins action:
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 to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No
❑ NA ❑ NE
permit? (i.e., discharge, frecboard problems, over -application)
31. Do subsurface the drains exist at the facility'? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ❑ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes ❑ No
❑ NA ❑ NE
ments (refer to question #): Explain any YES answers And/or any additional recommendations or anylother comieots ^;
FUse
drawings of facility to better explain situations (use additional pages as necessary).
2- La
La) 0 0 Vk 5
Z �
LA -50 o� 1 S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: c6
2/4/2011

ti .-, - r; r ac ;;, . :.i` + .:i '' :.➢7°'� .Y 7:1'5,i '.I`.'Cz., ;.a',K .r•'F'S ';T, .. ..'` _ .. l'�".,1.;K ",
Facility Number: - -3 113ate of Inspection: t✓ Zi /
,
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 to provide documentation of an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other issues
ti
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
0 Yes
❑ 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
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
[] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional probiems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33• Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
❑ No
❑ NA
❑ NE
Comto question #): Explain any answers and/or any additional: recomendations or anyFother icomtnentsl
(refer m
u, V
draments
Use wings .of facility. to.better explain situations (use additional pales as necessary).
� " :y
:_ t �tAt
., F l
I? ..r'� rs C` GNC-, t•o r,_Q.;'
J rf
a °OV l f 5 �� .. Deed
6
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 614111(r
2/4/2011

I
• Division of Water Quality
Facility Number - 0 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 8 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: lt<!� Departure Time: 0-' !�,► County: * QDrA Region: �e7
Farm Name:
Owner Email:
Owner Name: /`� G P s u-- 5 _s-,�. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
K
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 5*o O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other.
Other
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [�FNo ❑ NA ❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
❑ No
[�T NA
❑ NE
❑ Yes
❑ No
TNA
❑ NE
❑Yes
®No
TF;�
❑NA
❑NE
[3Yes
No
❑ NA
❑ NE
Page 1 of 3 214/1011 Continued

%.,
❑ Yes
❑ No
❑ NANE
Facili Number: Date of Inspection: p
❑ Yes
❑ No
❑ NA
NE
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:2-
❑ WUP F1 Checklists [:]Design ❑ Maps [:]Lease Agreements
[]Other:
Spillway?:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
Designed Freeboard (in):
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Observed Freeboard (in):
❑ Rainfall []Stocking. ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
5. Are there any immediate threats to the integrity of any of the structures observed?
F] Yes
Q5 No
[DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA
® NE
Page 2 of 3
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes
❑ No
Q NA
P0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[�iNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
4 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
E�] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
[T NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NANE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
t9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
❑ WUP F1 Checklists [:]Design ❑ Maps [:]Lease Agreements
[]Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
ONE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall []Stocking. ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
® NE
Page 2 of 3
2/4/2011 Continued

S.
Faciiity Number: _/L - Date of Ins ection: n 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 ❑ 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:
❑ NA NE
❑ NA NE
❑ NA " NE
❑ NA 1� NE
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA f�j NE
❑ Yes []No ❑ NA P NE
❑ Yes ❑ No ❑ NA CP NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
4C47�
❑ Yes
❑ No
❑ NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
® NE
T
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
NE
Comments (refer to question fl, Explain any YES answers and/or any additional recomtnendatlons;or any other comments :
'3
Use drawings of facility to better expinin situations (use additional paces as neeessan .,
= * '"'144M
Q
(a)pp �-, 1 1-5 014
Layo r I-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0
Date: 3d
214/2011

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint 0 Follow-up C) Referral 0 Emergency O Other O Denied Access
Date of Visit: S/I IZ, Arrival 'Gime: FOTI Departure Time: I/ Q.� I County:/1 j.91t,��DA�tq,�,
Farm Name: IT�zi,yQ r -sl CQ v-. Owner Email: f
Owner Name: AIC, P11.,- ji"S ;►'"'s Phone:
Mailing Address:
Physical Address:
Facility Contact: fk lq Title:
u
Onsite Representative:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai HeifeF--:::]r
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Ur, P,onitr
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
Pullets
11jecturood Caw
'I'urke s
Other
'I'urkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes F No ❑ NA ❑ NE
❑ Yes ❑ No Q NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [�q 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 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes fp No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EoNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: 3 Date of Ins ection: 2.t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier: ' } 2_-1ok G—
Spillway?:
Structure 4 Structure 5
QA'111
No NA ❑ NE
No ® NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in): 2 bj J(}
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No A E3 NE
(i.e., large trees, severe erosion, seepage, etc.) TT''
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo ❑ 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 MNo NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P No WA 1A ❑ 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 P No DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ 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?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C] No
fn 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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
M NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
W 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
C] No
fn NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
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

kaefli Number: OC jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes ❑ No 09 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 [] 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No
❑ Yes [:]No
NA ❑ NE
® NA ❑ NE
❑ Yes ❑ No M NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
[]�NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
�q NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? 0 Yes ❑ No t2 NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendationsAor�any 0' We comments: 1
Use drawings.of facility to better.ex lain situations (use additional pages As necessur )
.i'v` 0.c-►�.-Q-- `� w
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Dale:
Azo r

Type of Visit: 40 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 41 Routine O Complaint Q Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: p 10o M Departure Time: 2 p0 County:6`1tYV n!! egion: /C V
t r
Farm Name: e2► ►/ov<tt );i. m Owner Email:
Owner Name: Air, �C1�✓✓i.$ 6,,,n 4 t '77 , C, Phone:
Mailing Address:
Physical Address:
Facility Contact: _ A0,1 0of-e Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
t, �Dcsign Current )ti �Fi r Desi' n Current Desi n Current
Swine CapirtyPopr�f�Wet Roultry Capacity Pop. Cattle Capacity Pap.
Wean to Finish`: La er Dairy Cow
Wean to Feeder Non -Lai Dairy Calf
Feeder to Finish ,^°" a 4 �� µ. Dairy Heifer
Farrow to WeanDesign Current D Cow
Farrow to Feeder �' # 3..`, Drflp-iaci ,o P. Non -Dairy
Farrow to Finish ;!~ Layers Beef Stocker
Gilts F Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Otherlaw
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation'? [] Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
[�)NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[!�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
CpNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

I
Facitit Number: IDate of Inspection: 411 ZL/
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): IFF
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 P No ❑ NA ❑ NE
waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[)a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
r" NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
❑ Yes
❑ No
❑ NA
NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. D Total Phosphorus D Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
rj
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
P NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
M NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
❑ No
❑ NA
q 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 ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA I NE
❑
Weather Code
❑ Sludge Survey
❑ NA NE
❑ NA NE
Page 2 of 3 1/4/2011 Continued

f Facility Number: Date of Inspection: _ZZII _j
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 IM NE
the appropriate box(es) below. Le
❑ 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 [Z] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA Ep NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA T NE
❑ Yes ❑ No ❑ NA �] NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
PA No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA [PINE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes ❑ No
❑ NA TM NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No
❑ NA E�NE
Comments (refer to question #): Explain.any YES answers and/or any additional recommendations or any other comments k;,,�7+;'
Use drawings of facility to better explain situations (use additional pages as necessary).
45
(� oDV► r 5 bid 3 P
Doul,
ag
L'IJ 0 00M
jf7D+'t
Reviewer/Inspector Name:
Reviewer/Inspcetor Signature:
Page 3 of 3
Phone: 91 ,0 —Y33" 3 3 Co
Date: 411-711t
2/4/2011

V.
Type of Visit 49 Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit o Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 8 O Arrival Time: Departure Time: d fCounty: &,�lG Region: YCRO
Farm Name: 1 VWC, t t° Owner Email:
OwnerName: /,3& PLW U1 f.Q�n"_S_ -r+G _ Phone:
Mailing Address:
Physical Address:
Facility Contact: -T—oh Title:
Y
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: t"1W t/ i S
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F-10 01 =11 Longitude: ❑ o 0 s =64
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA.
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C*apacfty Population
Cattle Capacity Population
❑ Wean to Finish
❑ L a er
❑ Dairy Cow
❑ NA
❑ Wean to Feeder
❑ Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
[�NE
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Cold
❑ Yes
❑❑Beef
Turkeys
❑ NA
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA.
fffNE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
[ %E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
[�NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
EP
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
[RIE
other than from a discharge'?
l
Page I of 3
12/28/04
Continued

ti
Facility Number: Date of Inspection to
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier. �3
Spillway?:
Designed Freeboard (in):
r
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 ❑ No ❑ NA �NE
❑ Yes ❑ No ❑ NA EPNE
Structure 5 Structure 6
❑ Yes
❑ No
❑ NA
r NE
❑ Yes
❑ No
❑ NA
INE
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? L Yes EpNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [)�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes 1�ffNo [INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �? NE
mai ntenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes []No ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
tP NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
C�NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
� NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
❑ No
❑ NANE
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ No
❑ NA
NE
'.Comments (refer to question #): Explain; any YES answers and/or any recommeodahons or any other comments
,Use drawings`offacility'to better explam'situations. (use. additional pages as necessary): k1j.
� 1>
Reviewerlinspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: fJ. r
Date: W/D
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ 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 [:1 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
❑ No
❑ NA
THE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
FINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility tail 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
I�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
FNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NANE
yl
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
1P 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
FNE
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
�!PNE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
❑ No
❑ NA
n NE
Addidonal''Comments and/or Drawings:
A.
Page 3 of 3 12/28104

Division of Water Quality
Facility Number : 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: fQ/f7 /j Arrival Time: n1,0o m Departure Time: }�U r County: AaI4��kegion:/CyQ-,O
r � �
Farm Name:! U QHS t�y�„ _ Owner Email:
Owner Name: r , rpt-�'+�I.S V 1�.+'`i r T e-, Phone:
Mailing Address:
Physical Address:
Facility Contact: /art God Title: Phone:
Onsite Representative: Integrator:
' 3 ,
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
a
Swine
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I I Layer
Wean to Feeder I INon-Layer
Feeder to Finish :250
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Canacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3, Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ®, No [:]NA E] NE
❑ Yes ❑ No 0, NA ❑ NE
❑ Yes ❑ No Q�NA ❑ NE
[:]Yes ❑No
L] Yes LJ No
❑ Yes t`tNo
[{:NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

acili Number: - Date of Inspection: 41 / /1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
" Identifier: 2—
Spillway?:
Designed Freeboard (in):
Structure 3 Structure 4 Structure 5
No [3 NA ❑NE
❑ No T ' NA ❑ NE
Structure 6
�i
Observed Freeboard (in): � i 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes © No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) '
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) '
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA [ENE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ❑ No ❑ NA 0 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA © NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA © NE
r
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ® NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA M NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA © NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA SINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box. `
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA 4 NE
[:]Weather Code
❑ Sludge Survey
❑ NA NE
❑ NA'NE
Page 2 of 3 2/4/2011 Continued

acilf Number: 02- Date of Ins ection: �c//?'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No [] NA R] 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 F-1 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 faii 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 © NE
Other Issues
'i I
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[] No
❑ NA
1� NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
® NE
If yes, contact a regional Air Quality representative immediately.
1
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 the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
" No
E] NA
E] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
[ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
❑ No
❑ NA
Cb NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
M71oNE
Comments (refer to question #):Explain any YES answers and/or any additional recommendations or.any other comments 4 b,,�',i,Ps,tiLi #
Use drawings of facility to better explain situations.{use additional pages as necessary).
Ar ("21) �` s
9DVO H
�
,
Lloo
IS 0 / j #L�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/j) -V_3'? -33e0
Date:
1/4/2011

-S 'AU0
Division of Water Quality
=Fecilityumber Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 1�Compllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit QrRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I4' S Departure Time: a ,1 - N1 County: Region: 02,10
rr DOo1*
Farm Name: %
9I i u� R&-,,7 rt'{ly�sti?c > Owner Email:
Owner Name:
Mailing Address:
Physical Address: 11 ;
Facility Contact: TY`1 �40Q'� Title:
Onsite Representative: T -6) Moate
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No: �A�0 Y
Integrator• ' n `i $ 1
Operator Certification Number: N911
Back-up Certification Number:
Latitude: =0 =4 Longitude: = o =
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
I❑ Non -La es
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
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
ElBeef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IRNo ❑ NA EINE
[]Yes
❑ No
[INA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[,2 No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection l ,gym
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes 1p No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?.
Designed Freeboard (in): �$
Observed Freeboard (in): 2D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
CR No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
Di`No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
d 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? 51 Yes
❑ No
• ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
li� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
CR No
❑ NA
9. Does any part of the waste management system other than the waste structures require ❑ Yes
CS No
❑ NA ❑ NE
maintenance or improvement?
Waste Ammlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1 -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 from those designated in the CAWMP?
❑ Yes
q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
d No
❑ NA
52 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[S No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
CR 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):
Reviewer/Inspector Name sJ' .er v Cr- � _ Phone: t_ M `133-33U7 X3337
Reviewer/Inspector Signature: Date: 3
12/28/04 Continued

Facility Dumber: a Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No [:INA 5aNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [ kNE
the appropirate box.
❑ 1'VUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IR 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
ER No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[N NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
❑ No
P NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
151 No
❑ NA
❑ NE
27.
Did the lacility 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
RNo
❑ 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
jgC 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
r8tNo
❑ 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
10 No
❑ NA
❑ NE
Additional Comments and/or Drawings: t *�
occtassMalValio es r ran L , VJ �� I lie
7� pie se, c-.� by o od 9 row t� c� be, i m ide 1k, joy,
y
Page 3 of 3 12/28/04

Facility No. _Farm Name fiegi2kDate "51
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert }
Lagoon 1 2 3 A 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & % $ �1
Liquid Trt. Zone ft
S no a t eel a I I#No 6 ..-►
OEM
Soil Test Date
pH Fields iT
Lime Needed 0.!!�
Lime Applied
Cu FDO Zn
Needs P
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware
S /�V A
Xnce
�,&+��� mi �:

Facility Number
10 Division of Water Quality T
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit JOLCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access f�r�
Date of Visit: ZD Ar-.= Time: = Departure Time: County: Region:
Farm Name: ; Mrs;
]e. ��X1's1—L Owner Email:
Owner Name: NC -1 S Phone:
Mailing Address:
Phvsical Address:
Facility Contact: Title:
Onsite Representative: Y1 O'DYY
C,
(Tk �
Certified Operator: �; � `]ne_s
Back-up Operator:
Location of Farm:
Integrator:
Phone No: [ P cAS 7(o- K
6 V'6
Operator Certification Number:
Back-up Certification Number:
Latitude: [=O = = Longitude: [= ° 0 t =,6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Dischari!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 Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heitei
E]Dty Cow
❑ Non -Dain
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters orthe State
other than from a discharge?
❑ Yes D(No ❑ NA ❑ NE
❑ Yes
❑ No
INA
❑ NE
❑ Yes
❑ No
U)NA
❑ NE
�IA
❑ NE
❑ Yes
❑ No
❑ YesNo
C3NA
ElNE
ElYes
No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: (0`L -- (] Date of Inspection
❑ Yes
❑ No
O NA
Waste Collection & Treatment
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ No
O(NA
❑ NE
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
*o
❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
) i No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit?
❑ Yes
[:]No
❑NA �KNE
(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
V No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�(No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
'�ZLNo
❑ 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) Fe3c-Lt e
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
O NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
)4NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
ZNA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
❑ No
O(NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
w
Reviewer/Inspector Name Sri 0 Phone: 3 37
Reviewer/Inspector Signature: _ ,t, ' �_ __ _ _ __ Date: F61 ZO 2d0
12/28/04 Continued

•' Facility Number: —0-3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes ❑ No 19NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No [XNA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists
❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No §;rNA ❑ 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
X No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
C3 Yes
❑ NoA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
INA
C:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
Cl No
;4NA
❑ 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
❑ No
VNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NoNA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o
❑ 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
�zNo
❑ 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
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
ditional Comments and/or
12/28/04

Mcxvk
--�ifity No. �VV JJ Time In Time Out Date d�
-Farm Name v'Q S� C `` ( r`� integrator __ ury is -
Owner M Cnn Pufyi� _ _ Site Rep ~)ur)kjx
Operator No.
Back-up No.
COC � ircle: General or NPDES
C
Design Current Design Current
Wean — Feed Farrow — Feed
Farrow — Finish
Feed — Fin isLZ Gilts 1 Boars
arrow — Wean Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge
Soil Test
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Date
Observed
Calibration/GPM-- 1
Waste Transfers
Rain Breaker
PLAT -- Wettable Acres
Daily Rainfall
120 min Inspections
Nitrogen (N)
Z-II-og .Z$
t i - (c, • �V
19-Z.-O-7.gf
1 -in Inspections
Date Nitrogen (N)
5 -Z. .0
Pull/Field Soil Crop Pan Window

Type of Visit "'aCompliance 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: 01 Arrival Time: Departure Time: County: Region:
Farm Name: TeX S (�e . ���--���------ 0��+--w���ner Email:
Owner Name: ter V Phone:
Mailing Address:
Physical Address: ``'j�'
Facility Contact: I _d71�n. I��� _ Title:
Onsite Representative: ' cl7ita
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 0I = Longitude: =° [=4 0„
Design Current
Design Current
Design Current
wine Capacity Populat176
Wet Poultry Capacity Population
Cuttle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
a. Was the conveyance man-made?
❑ Wean to Feeder
[01
on -Layer
NA
❑ Dai Calf
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Feeder to Finish
❑ No
❑ Dai Heifer
❑ Farrow to Wean
l?aultr
❑ D Cow
Farrow to Feeder
"' `yamy
❑ Layers
ElNon-Dairy
❑ Farrow to Finish
❑ Yes
ElBeef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
ars
❑Pullets
❑ Beef Brood Cowl I
❑ NE
❑ Turkeys
❑ Yes
Other
❑ Turkey Poults
❑ NE
❑ Other
❑ Other
Number of Structures:
Discharges & 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
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

^ Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Pio ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No A2VA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
` 5. Arthere any immediate threats to the integrity of any of the structures observed'? El Yes El No
L�iE
El NA
ar a trees severe erosion seepageetc.
Reviewer/inspector Name_
S Phone:
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ❑ No
❑ NA
kagE
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? �a Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No
❑ NA
kNE
(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
�NE
❑ Yes ❑ No
❑ NA
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA�NE
maintenance/improvement`?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Flo
❑ NA
Q NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ Yes
16. Did the facility tail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
❑ No ❑ NA 'KNE
❑ No ❑ NA �;NE
❑ No ❑ NA NE
❑ No ❑ NA NE
❑ No ❑ NA 'ONE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments Y `t`,;��
Use drawings of facility to better explain situations. (usc:additional pagesYas necessary):.
Reviewer/inspector Name_
S Phone:
47j t
Reviewer/Inspector Signature:
Date:
mg— Z�
Page 2 of 3 12/28/04 Continued

lFa4lity Number: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 ElNo [INA JONE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ 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 121,No ❑ NA
❑ NE
23.
]f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
❑ No 'KN A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No )ZVA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No Iq NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No ANA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NoA
❑ NE
Other Issues
����' vvvv�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ANA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No `�NA
El 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 �A
El NE
If yes, contact a regional Air Quality representative immediately
3l.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[]No VNA
❑ NE
General Pen -nit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
;gtNo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No ❑ NA
❑ NE
Additional Comments and/or Drawings:
Qe eine b
CA a
r3
Page 3 of 3 12/28/04

ENVIRONMENTAL ENGINEERING SERVICES
Water • Wastewater • Sludge • Agricultural • Industrial • Civil
NCDENR
Division of Water Quality
c/o Sue Homewood
1617 Mail Service Center
Raleigh, NC 27699-1617
ECE1Vr0
JUL 2 4 2000
REG. OFFICE
February 4, 2000
Re: Certified animal waste management plan revisions for the Riverside Farm, State Road #
1543, Montgomery County. Facility I.D. # 62-003.
Dear Ms. Homewood,
The Waste Management Plans and Specifications for the above referenced farm are now
complete. Please find enclosed one copy of the new revised Certified Animal Waste
Management Plan for Riverside Farm. Little River Farm has been taken out of this plan
and made into a put into its own separate package.
After you have read this information, please let me know if I need to re-sign the certification
forms for this farm. I look forward to hearing from you on this matter.
ac: Melvin Purvis
Anthony Moore
enclosures
vices
P.O. BOX 426, ABERDEEN, N.C. 28315 - PHONE [phone] - FAX [phone]