630004_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

' f]1 ision of -later Resources
Facility Number - Division of Soil and Water Conservation
QQ Other Agency 0
Type of Visit: ® Compliance inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Ot', C6k, I Departure Time: 027'� County: Region:
I,
Farm Name: ro,, k01 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: w` Title: Phone:
Onsite Representative: �. integrator: /�� I Cv►-✓P s
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Dcsign C+urrent
Swine '
Capac ty I'op.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Z
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr,
Ca acit
P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eeffeeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
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:
a. Was the conveyance man-made?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No LNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
❑ No
M 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 DWR)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of 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
M No
❑ NA
❑ NE
of the State other than from a discharge?
T
Page I of 3 21412015 Continued

Pacilit— Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J4 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
7 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in):Ll �
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
7
❑ 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 P No [DNA ❑ NE
8. Do any of the structures 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 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? Ifyes, check the appropriate box below. [:]Yes 0 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 Wind
w Q Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��'� SG^l V"q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1� No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
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? Ifyes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[?] No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
[PNo
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

J
acili `Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? []Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T® 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?
r
24. 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
rm No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storagc Pond ❑ Other:
T
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
any. YES answcrsand/or any additional:'recommendationskor any other comments, .
Comments (refer to, uestion #): ExplainItv
Use drawings offacilityto better explain situations;;(use,additionalipages ,asnecessary)s•.$...;:` m
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910 , 33op
Date: O
21412015

ivision of Water Quality
Facility Number ®- ® O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Wcoompliance Inspection 0 Operation Review � Structure Evaluation Q Technical Assistance
Reason for Visit: t36outine O Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Oa Arrival Time: bis rn Departure Time:® County: MmkE Region: FRO
Farm Name: F.y ragrn Owner Email:
Owner Name: `j E_. _ i* Phone:
Mailing Address: rJ' Q tp e RNLCts (�0(-N4 Rob)osr%\s He. a-)3as-
Physical Address:
Facility Contact: &I b-9,1 Title:
Onsite Representative: 1�1 Am
Certified Operator: GT,bLp'-r 1Z��
Phone:
Integrator: Ncz Puawm 'FoRrms.-INC
Certification Number: 1 F5 3 ( 3
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters -of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes �No ❑ NA ❑ NE
❑ Yes
[] No
NA
❑ NE
❑ Yes
❑ No
[2(NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes dNo
❑ Yes [4 No
G�NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: t05 - Qp jDate of Inspection: b rdZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ya,
❑ NA ❑ NE
5ZNA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[:]Yes
dNo
❑ NA
❑ NE
❑ Yes
[Z"No
[,] NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E2"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as -required by the permit? ❑ Yes Fv-KNo ❑ 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"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
I.I. 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): Vf SCuf
t 3. Soil Type(s): N Nscgu
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L%No❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
[E f No
❑ NA
❑ NE
❑ Yes
[yNo
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [EI'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [fNo ❑ 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 YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [3Soil 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 [2rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [2"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Lg3 - 0014 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Cy"No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑3"N' o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
E;KNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[2'*No
❑ NA ❑ NE
Other Issues
29. 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
h o
❑ 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
(3/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
[g4Io
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2"No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ff No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Z No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
X-
N E-P-o
Sosx_
a;,"% Qr E_ zf\
N�m
!4Qtka'_(
z me 'Nk=or
M Err: CAS 1b vto'Aaoro TN as 1
Reviewer/Inspector Name: 40e.\ e\ flS Phone: Ck%( -�- UgS l
i
Reviewer/Inspector Signature: 6 Date: ;L i
Page 3 of 3 21412011

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 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: j County: #7qW,
Farm Name: ��U�'—��L✓w1 Owner Email:
Owner Name: C"7✓ Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 6 7Title: Phone:
Onsite Representative: k integrator: /y(�- 004.4-w-' iGAS, a6a '
Certified Operator: U Certification Number: W 13
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Haer
Non -Layer
Design Current
D 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.
DaitySow
Daig Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [n No ❑ NA ❑ NE
❑Yes
❑No
[ENA
❑NE
❑ Yes
❑ No
[]3 NA
❑ NE
[:]Yes ❑ No
[:]Yes No
❑ Yes No
�N ❑NE
® ❑ NE
❑NA ❑NE
Page 1 of 3
�r
21412011 Continued

t`
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ep 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: .1
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
N 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
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
[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.
[7 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): Pegtrp cpgs�]
13. Soil Type(s): IVA500
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 50 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
I& 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
❑ 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 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
EP No
❑ 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 [PNo ❑ 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 P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fS 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?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes fa No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes L No
[]Yes 1�3 No
❑ Yes E�j No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or'any additional recommendations or any other comments >
Use drawings of facility to better explain situations (use additional pages:as necessary)..
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: F/o-Y�"33C0
Date: _6h6h,
214/2011

f Division of Water Quality
Facility Number J O Division of Sol] 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 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: t + 1 om=
Farm Name: Owner Email:
�%,,I
Owner Name: F� f� Phone:
Mailing Address:
Physical Address:
Region:_
Facility Contact: __ _ Title: Phone No:
In �
Onsite Representative: Integrator: l9 UVVf
Certified Operator: 14 Operator Certification Number: lu 31-3
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 00 Longitude:
mtlf5 Wes o�—' P%bISMS Or-F 4,7 ?K-
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I� Layer I I
Non-Layer
J
s _ r
Other
❑ Other___
Discharges & Stream Impacts
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: [E]
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
i
❑ NA
❑ NE
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
MNA
❑ NE
b.. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
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
[PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
3. Were there any adverse,.impacts or potential adverse impacts to the Waters of the State
❑ Yes
N No
❑ NA
❑ NE
other than from a discharge?
\Page 1 0f 3 12128104 Continued

Date of Inspection
gacility'Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
[INA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
,K 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
A 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
W 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
[0 No
❑ 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
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[I'No
❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidencfp-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
i" 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
T` No
`KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
❑ NA
❑ NE
'Comments (refer to question #): -Explain any YES answcrs;and/,or"any recommendations or, any otherecommen�ts
Use drawings of facility to;better; explain situations. (use additional pages as�neeessary.)i tVl'
� � � ;
Reviewer/Inspector Name sffi
v t` �.-w� Phone:
Reviewer/Inspector Signature: Date: .
1 R d Continued
n .J

r acuity Number: Date of Inspection ,3
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 ail components of the CAWMP readily available? If yes, check ❑ Yes 11No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ""o No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
01 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�9 NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
NA
P
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ANo
❑ 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
ys 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 ReviewerAnspector 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
1p,No
❑ NA
❑ NE
Additional Comments and/or'Druwings,:
�
Co
f A W, t`ct w�S - Al ��
�o Cs,r�r�c'� [�%aS P�41�1,
i
Page 3 of 3 12129104

aDivision of Water Quality
Facility plumber 0 Division of Soil and Water Conservation
0 Other Agency
F
f Visit 6Compllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit � Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r Efl Departure Time: 11 jjQ2AM I County: Region:_
Farm Name: V-Py
T
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address: QG_ (6A,0..SS J _ fCf1�1sOf
Facility Contact: Title: _Own#- Phone No:
Onsite Representative: Integrator: Pufll?l
Certified Operator:. It+h&f- Operator Certification Number: 18313
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o Longitude: = o =1
Swint
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Im[acts
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 Populatiom•.
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes tgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[]No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

FacVity Humber: —Mql Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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?:
7
Designed Freeboard (in): 1M
I�
Observed Freeboard (in): a0S`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ErNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PTNo ❑ 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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes N"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?M 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
IR'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name mcg Phone: [phone] X=
i
Reviewer/Inspector Signature: Date: AkIllit aw
V 12128104 Continued

Facility Number, — Datc of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [3 Maps [3 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5 '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?
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? '
❑ Yes
[�kNo
❑ NA
❑ NE
❑ Yes
❑ No
ERNA
❑ NE
❑ Yes
C'No
❑ NA
❑ NE
❑ Yes
❑ No
&NA
❑ NE
❑ Yes
J No
❑ NA
❑ NE
❑ Yes
❑ No
EWNA
❑ NE
❑ Yes SNo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes IRNo ❑ NA ❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
29No
❑ NA
❑ NE
Additionsl:CommcntsandlorUravinls,.
16, Re6e.h&e, W654e_ elm rnodM%( io C&Ie' eXt'a- -06L 4 solid s- find t�p
a5-15p%pt from s l,0 - s vw -Far 3009, P&v e do a 'e t� ao ©q ,
ay, Ca [t bcAcn rt� a ooa
aI1 elfge sf ^ �jtP�_as a+. Coo f sebfy- ,
Fxcefl + -horn 4 joad_ re ands ,
C,00k sose(Oticr C� VOM) CQpr1 OA$ 0, 0 IRA,
Addf6a clk;f its nole!J rim faM C60,
S0 My- -Pa- l a r}- 3 je&i (arrtad � �J�Fa-,��� �4�e b� C at fa j 0 r*, TT e_
QM�� w� 9 �'Ne� +1E- 0&1 tO Tread solfd>r irl 0 end >ar 4 e
C.heckfd di -htf- ca+rcih of a�gtiri�lr,
Page 3 of 3 12128104

Facility No. �0.�-�iFarm Name Date
Permit COC OIC NPDES (Rainbreaker PLAT
Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Desi n freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
Slyd�eE�pfiA -RY a�Aoo,eaao�
Calibration Date
W4 rl
Soil Test Date
�
®g
� -
1 in Inspections
pH Fields
.
Crop Yield
120 min Inspections
Lime Needed
Wettable Acres
Weather Codes
Lime Applied
WUP
Transfer Sheets
Cu
Zn L/
Weekly Freeboard
RAIN GAUGE
Needs P
�_
Rainfall >1"
r - -
�
r�r Mr 1��r��
.�".��il�»��
�,
mQr�'��
s�•'i:11�.►R''
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
-sn i -
NO
.4 1hr
1,0
-t
1
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Q10-7 Date last WUP at farm q
FRO or Farm Records
Lagoon # I
Top Dike
Stop Pump
Start Pump 'Sq ip
aa'
App. Hardware

w
04),
„oQQ a(u
40,no�

Facility Number 63
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �r,� % P� Departure Time: County: Wr Region: i—fC
Farm Name: Ket, F7drM Owner Email:
Owner Name: 6Phone:
Mailing Address:
Physical Address:
Facility Contact: (L (bwl— tom! Title:
Onsite Representative:
Certified Operator: 14
A } Phone No:
Integrator: I" G- puv- u1 S
Operator Certification Number: 1831.3
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
IL Farrow to Wean I
L Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: = c = 6 = Longitude: ❑ ° ❑ ` 0 f`
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer EEI
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
. 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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 [DNo ❑ NA ❑ NE
❑ Yes
❑ No
tTNA
❑ NE
❑ Yes
❑ No
[)PNA
❑ NE
❑ Yes
❑ Na
, zt NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
ElYes
o
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 Date of Inspection I S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ❑ No ❑ NA [INE
a. If yes, is waste level into the structural freeboard? Yes ❑ Na NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 §tructure 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J,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?
in Yes
❑ No
❑ 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
M No
Al
❑ NA ❑ NE
maintenance or improvement?
Waste Application
r
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
F,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
'n Outside of Area
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ZKS
12. Crop type(s) Fy C "ft lh�C�IQ
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ElNE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
INo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
fj9,No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
t�No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fR-No
❑ NA ❑ NE
� Mid & i`.�v' � �.l'I� r+.'4:,p _ �,'�
Cantments (referkto question #) Explain army YES answerrslandlfor anyrecommend ti ns ur any othe comments, 4
iU�s,qe,drawqings ofFfacility to better xplaln situations.t{usegadditlonat Ages; nec„e(ssary):
Reviewer/Inspector Name e -- -� Phone:
Reviewer/Inspector Signature: Date: %9 t�
Page 2 of 3 12128104 Continued

r I`
Facility Number: — Date of Inspection S 11
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 El Other
❑ Yes
'�'o
❑ NA
❑ NE
❑ Yes
�yNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
d!�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JgNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JpNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
b 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
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
[I NA
El NE
Addid onal.Gommi:nts,and/or Dr:Wins : ;wf '� ''
' ,��:S fi z z �: ���{r; , �.7 t*
i
Page 3 of 3 12128104

IType of Visit -9�Compllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Woutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
a Departure Time:
Date of Visit: � Arrival Time:
Farm Name: [� fY-\
Owner Name: 1 •-C
Mailing Address: _
Physical Address:
County:
Owner Email:
Phone:
Region:
M
Facility Contact: .Q: w1 Ri Title: U lkyyX Phone No: L q( `[ 3567
Onsite Representative: _ _ _I_ b Integrator: Iry t S
Certified OperatorcKkAOperator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
eederto Finish
Farrow to Wean
arrow to Feeder �—
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 c 0 ` = " Longitude: = ° = ` 0 "
Design Current
Wet Poultry Capacity Population
Layer
Non -Layer
Dry Poultry
❑ -Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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
Cattle,Capacity P.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes IgNo ❑ NA ❑ NE
❑ Yes
❑ No
[ NA
❑ NE
❑ Yes
❑ No
[jPIVA
❑ NE
WA
❑ NE
❑ Yes
❑ No
❑ Yes
�'No
❑ NA
❑ NE
❑ Yes
®'No
❑ NA
❑ NE
12128104 Continued

Facility Number: I& —+oa'-
Date of inspection
Waste Collection & Treatment
tql
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 4 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
t r py h
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
(ie/ large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed ❑ Yes _�tNo ❑ 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 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes *o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement? ❑Yes o ❑ NA El NE
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes [� No ❑ NA ❑ NE
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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) t
i
(Qorl
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
to
Cl NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J�[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I C14k1 / AJ 1117"Q /v I Phone: Q % U Y'33 3,350
Reviewer/Inspector Signature: Date: Ime-di ,22 �yj
Page 2 of 3 ?/0
12128104 Continued
33Y'—c✓�'�ec-�

r
Facty Number: — Date of Inspection- a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JVNo ❑ 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 _KNo ❑ 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 ANo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
❑ NA
)VNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ YesoffXNo
❑ NA
JtNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ;ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes _J�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes jTo
❑ 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 duality concern?
❑ Yes ONo
❑ 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 EgNo
❑ 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 FXNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes 6No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a�l/f
nwd" �1111c>
i
111 u.S-�' �i1) a UCr-i�- C9L► r& is a 1-1 .
; rms d � 5pra�..,� 5-�ASor�d 5 .
N : ce- So Sa �a.r a-�a�. S��S--►�, ay�d V�r rr� , r� c �` 1; ,
Page 3 of 3 12128104

� V � Y " ' -L •
T
� �iVrvu �
�
FacilityNo. �J�'
�0 Time In Gl
Out
Date � �� 0
.Time
Farm Name
Integrator
v r v rz
Owner . i
1/
`I c�
Site Rep
Operator
No.
Back-up
COC ��
Circle: General or
No.
PD
d& b
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Farrow -- Finish
Feed — fin'
D
Gilts 1 Boars
Farrow — can
Others
FREEBOARD; Design rz Observed
Sludge Survey Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test L PLAT Wettable Acres ✓
Weekly Freeboard —_�_ Daily Rainfall ui 1-in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
Ve
c,4cV—
r r
7 "�

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Vislt
0 Routine 0 Complaint
0 Fallow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; ' p Departure Time: County: &A2nV=. _ Region:
Farm Name: Z� ny-t,. Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 5.�.L �L „•_ ,.•_• Title:
Onsite Representative: _ �. M UP..,,,,•. _•„_,___
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 -
Phone No:
Integrator:�/i5
Operator Certification Number:
Back-up Certification Number:
Latitude: o ❑ Longitude: = ° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
..,,._, ❑ Layer
�! ❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: ®,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �tNo ❑ NA ❑ NE
❑ Yes
[No
❑ NA
El NE
❑ Yes
OkNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

4' k
Facility Number: 3—
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): p�
Observed Freeboard (in): ,3
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 0 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 4No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? J,Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IR No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) N/J,S Iry /I%Q s Dw +U
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �3No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Dd No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[--] Yes ®No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No , ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes QNo ❑ NA ❑ NE
�Jl77A0,f'4Y��i+ty��t7iTt+7�
� <. v :. x t dim � .4"��p'$4�' � i 7 :. s
Reviewer/Inspector Name yaw
N� Phone: �%/.Y
Reviewer/Inspector Signature: Date: Dw
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 21 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
®-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C9 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
Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
UKNo
❑ 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
Z 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
[XNo
❑ 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
4No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
ElNE
Aydditipnal Coimments'andlor':Drawin s , '�i t, "}� ° r jay'`
..� �!MI,' ?1']x r.. yp
12128104

r /
�..DIAsloiiof
E<:zWaF;t i atI. er'3Q'39' uFal`l! t[y
I nvsionof Sa11 saiWaterr
@gGo:. i set� rvir� a9 ,. pe nE !"iI
i
F9�Other AX ey
-,
Type of Visit WCompliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ denied Access
Facility Number [ G gate of Visit: 7 „ ime: 1 h
Not Operstilogal QBelw Threshold
® Permitted M. Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: b n k.C. County: , YVIfa, n6b.
Owner Name: Phone No:
Mailing Address: '� Mo14 e'r J '` Re 6 iv 1" s ,; LJ C-2732_c
Facility Contact: Title: Phone No:
Onsite Representative: YVN * • s-§ t Integrator: N G Pu s3
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude
Longitude
;D g '' Corr t
Design, • Current' ;; °Design Current D
Swine." Cap acityrll?o ulotion
" Poult Y.
Ca achy ' Po ulation , Cattle , .. Capacity Po uiation
�
Wean to Feeder
i
'
❑ Layer
Da'
`
® Feeder to Finish
+10
❑Non -Layer I
IJEJ
Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
'. ❑Other
's.
F
•. .
ilE yl
is
❑ Farrow to Finish
tt
g 9 i § r € F '.IE
' �i�.."- r .ti ., e � 3 �
Tatai DesigdCapaci
'
;°
❑ Gilts
aI �.�3.�1{.Wr.�;,
s.;"Tp�
,'.. ...BOSTs
a , ,-!1m ytt� Number of La onns 1 Subsurface Drains Present La oon Area ❑ S rav Field Area
I � 3i1,:-i5
ik Holdin Ponds'1 Snlld Tra s'' 3i
#i
; ❑ No Liquid Waste Management System
: r�1>,.,.,_� ; �u.$,r i(.,��°i
I.A.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ 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 & Ireatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 - Continued

Facility Numher: — Date of Inspection--D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [:]No
S. Does any part of the waste management system other than waste structures require maintenmcelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
fuse aravhngsjoittacwcy,40 letter exppmIstwanom tuseaaatnonw pages as1 ryl '� c.❑ Field Copy ❑ Final Notes
�f k q a �. t h� I H> p'
?�,' lid r}�i ► l it`i is 7 %:d #i tg.a'M iiiii�[ .li iLlL l� �il-M. 1 €11" f . F , a 3 � 1 ia�l < i�£ e_a , a ;ii �a N>: a:, a:} "
d Ab
Reviewer/Inspector Name
Reviewer/Inspector Signature:, .cGC Date:
12112103 Continued

Facility Number Date of Visit: �-� -t=�� Time:
Not Operational 0 Below Threshold
M Permitted ® Certified O Conditionally Certified [3 Registered Date Last Operated or Above Threshold.•
Farm Name: V—e W _!-'L._[1 County: _ _ _ 'i�t o 0 PC, _
Owner Name: G 1 i kert� Phone No: _ fi c 0 b — 3,t a -
Mailing Address: S qj[ to G n e ss I(�c� _ �Lia S lu G
Facility Contact: Title:
Onsite Representative: rz rc
Certified Operator: gri I (a r4' t�e
Location of Farm:
Phone No:
Integrator: P w'tii s
Operator Certification Number: 19 31 3
®swine ❑ Pouitry ❑ Cattle ❑ Horse Latitude 0' 0' �" Longitude • 1
Design Current
3wrne t:a scity ra ulation
❑ Wean to Feeder
® Feeder to Finish D
❑ Farrow to Wean k I .
IL Farrow to Finish I I I
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Po ulation
❑ Laver I I ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons rz a,< _Subsurface Drains Present ❑ La oon Area 10 S rev Field Area
.Holding Poads / Sblld Traps 0 _ p ❑ No Liquid Waste Management Svsfem
Discharges 8 Stream impacts
1. is any discharge observed from any part of the operation? ❑ Yes] No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b, if discharge is observed, did it reach Water of the State? (If yes, notify D WQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IRNo
Waste Collection $ Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Q9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): �.
65103101 Continued

Facility Number: — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
Wasted ication
10. Are there any buffers that need maintenance/improvement?
1 l . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes W No
❑ Yes ® No
❑ Yes [;!'No
❑ Yes [&No
❑ Yes V9 No
❑ Yes CS No
❑ Yes 1� No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [)_Q 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?
16. Is there a lack of adequate waste application equipment?
RegUired Records-& Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ Yes No
❑ Yes P No
❑ Yes $No
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

Facility Number: — Date of Inspection 1 c�
Odor J=U
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 biade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
f
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes CM No
❑ Yes No
❑ Yes No
❑ Yes ❑ No

0
DIVISION OF ENVIRONMENTAL MANAGEMENT
September 23, 1995
Mr. Gilbert Key, owner
Gilbert Key Swine Farm
596 Maness Road
Robbins, North Carolina 27325
SUBJECT: Compliance Inspection
Gilbert Key Swine Farm
Moore County
Dear Mr. Key:
On August 1, 1995, I had the opportunity to inspect your swine operation
in northern Moore County near Robbins. A copy of our Compliance Inspection
Report is enclosed for your information and review. Please note specifically
the comments concerning minimum freeboard requirements and the need for
mowing around the lagoons. This will be of benefit in'future inspections.
Thank you for your assistance in conducting this inspection. Should you
have questions concerning any items on the enclosed inspection form, please
contact me at [phone].
KA/ka
cc: Facilities Assessment Unit
Sincerely,
Ken Av itte
914

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm ?\
Mailing
County
Integral
On Site Representative: VA,
Physical Address/Location:
iit
DATE: $ , 1995
Time: Z: ,*
Type of Operation: Swine Poultry Cattle
Design Capacity: 290 CF,4 Number of Animals on Site: t2
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
(approximately 1 Foot + 7 inches) Yes or(la Actual Freeboard: Ft. f i Z- Inches
Was any seepage observed from the lagoons . Rio Yes or Was any erosion observed? Yes o�
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes r No
Crop(s) being utilized: v� '7S5C
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? es r No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orQ
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ore
Is animal waste discharged into water of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specify acteage w th cover crop)? Yes o> 0
Additional Comments: Aled0 3 A06,1ma Al 4ZWVUAe,0,
+j A J =--ktT7'S_
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
event
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