630007_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine Q Complaint 0 Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: (;r7 Departure Time: County: �OD
Farm Name: �e f �i�df t^" Owner Email:
Owner Name: �(,(�..J� Phone:
Mailing Address:
Physical Address:
.r--1
Facility Contact: c o Title:
Onsite Representative:
Certified Operator: `y w' 75, "i
Back-up Operator:
Location of Farm: Latitude:
Phone:
Region: j97,4kq
Integrator: gc _t'
Certification Number: 91-70% r
Certification Number:
Longitude:
Design Current�jl OWesign Current Design Current
Sw€ne Capacity Pap. Wet Poultry Capacity Pap. Cattle Capacity Pop,
Wean to Finish
ILayer
lDairy
Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
Dr. P,ouftr Ca ac3 Pa Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder 1 z
I
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
L_j0ther
Boars
Pullets
Beef Brood Cow
..thcr
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes F No ❑ NA ONE
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 DW R) ❑ 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 DWR) ❑ Yes ❑ No EPNA ❑ 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 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Jr
acilitX%Number: 3 -"7 jDate of Inspection: f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E iVA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes §3 No ❑ NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes � No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
1 1' 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 Ac'_e j)) able Crop Window ❑Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): �i7 W 11 t" Ir-I&S5 lb, ) IX]Q
--
13. Soil Type(s): �� aV
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
`t' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1� No
❑ NA
❑ NE
acres determination?
j
17. Does the facility lack adequate acreage for land application?
❑ Yes
P@ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1, No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
0 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
�0] 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
21412015 Continued

�Facflhy Number; 3- Date of Ins ection:
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 r773 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, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
( No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP7
❑ 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
COminCn"tsr(�frefer to qucstton;#} FzplAlnxany Y,ES answers undlor".'any additianalkrecommendatibns or'any"otliert"comments' L
' ' ::. Ah�• .5.s�3 � Skr 41.in f#.�-�'hi ;�wA/-' ■ P:TtU i...,,..'S4�+e.r, 4 V..4 - �
Use�drawin�s of;faclitty totb.etter,exulaln situatians'(usc. additional,naaes,asrnecessar0.1 tt-l'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ito- #77 73m
Date: X-1 + g
21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emerrency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: r Departure Time: B County: ArA24�_
Owner Email:
Phone:
" ► C�10 P_c Title:
Onsite Representative:101
Certified Operator: L50,
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator: ik_
Certification Number:
Certification Number:
Longitude:
Design
Current
Desigct
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pap..::
:�
Wean to Finish
La er
airy Caw
..
Wean to Feeder
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
O
©. Pouitr
Ga aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke si
OterlhiliellilmRol
ITurkeyPoults
Other
Other
�
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1� No ❑ NA ❑ NE
❑Yes No M7NA ❑NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

aclli ` Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(71 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^
Spillway?:
Designed Freeboard (in):
�� ' "
Observed Freeboard
(in) :
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�j 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
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
(
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evide
nce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �5�� caa-q'j �'tf s try Oye_
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
® No
[P
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[5� No
❑ NA
❑ NE
❑Yes [1No ❑NA ❑NE
❑ Yes [$j No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, D Yes F No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Wacifity, Number: Date of Inspection:
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 Z 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 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative`?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
[]Yes [allo ❑ NA ❑ NE
❑ Yes 53 No ❑ NA ❑ NE
❑ Yes Vj No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone:
Date:
21412015

type of visit: qP Uompliance inspection V uperation Keview V Ntructure Evamation V Technical Assistance
Reason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r uv Departure Time: County;
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone:
W
Onsite Representative: Integrator:
Certified Operator: Ciro {�' LSD Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current. Dea[gn Current . DeIn Current
city Pop Cattle Ca i Pap.
P h' P v Pty
Swine Ca aci Po . Wet Poult Capaim
am
Wean to Finish La er i DairyCow
Wean to Feeder
Non -La er
-. '
Design Current
x
Ca aci P,o
DairyCalf
Feeder to Finish
Du P,oult .
Daia Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
La ers
Gilts
113eef
Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
/n1 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
]�
a. Was the conveyance man-made?
[] Yes
[]No
[ A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[�j 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 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?
Page I of 3 21412014 Continued

Facil' Number: - Date of Ins ectlon:
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):
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 F No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
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 1�9 No ❑ NA ❑ NE
S. 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 1�] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Lm�n3 No ❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement? ❑ Yes Pa No ❑ NA [3NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I S. 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 0 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
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
21412014 Continued

i'acility,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 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
and report mortality rates that were higher than normal?
[] Yes �g No ❑ NA ❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
jj No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
TT
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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Coninients.(refer to question #): Explain any YES answers and/or any additianal recommendations or any other: comments `
Use drawings of.:facility<ta betfer.expiain,siWations{use additional pates as necessary).
`'77]
Reviewer/Inspector Name:
Reviewer/Inspeetor Signature:
Page 3 of 3
Phone: /0-4 3 _V06
Date: e�o
21412014

i i ype or visit: p uompuance inspection v vperarion rceview v structure r vaivarion v i ecnnicai Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access, <
Date of Visit:
Arrival Time: D.�a
Departure Time: 1 tea. County: OOI�—
Farm Name:
tt r
�e_jd
Owner Email:
Owner Name:
P&-R-Ltt
t3
Phone:
Mailing Address:
Physical Address:
Region: P
Facility Contact: ALOD2± Title: Phone;
Onsite Representative: t^ Integrator: r'J Pt t,,4DF
Certified Operator: i g w' 15B>� - _ Certification Number: 97 061 _
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop,
Wet oultry
Capacity
1'op.
Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
WSDairy
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Non-DalEy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
s
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imuacts
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 ycs, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
r] No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes [:]No
[:]Yes P No
❑ Yes EP No
[� NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili umber: Date of Ins ection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes gN No ❑ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 130 NA
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _
❑ NE
❑ NE
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
qNo
❑ 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
T�] 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
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E�)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
P-41 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
F
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
E� 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 ❑ Evidyflce of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): 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
P 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? If yes, check the appropriate box below. ❑ Yes Ep 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 P No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [50 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[]NA []NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�] No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
MA 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
�D No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
1� 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
[!P)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
1
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
"
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA ❑ NE
lCbiiiinents,(r6feritci question,#): Explain any; YES an er comments swers'an or an additional anal recommenda ons or:" y -any of
Usc drawings o , acility`2'#6,better,explain situations (use' additional pages as necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `�l 3
Date: `[ 2
21412014

R (i
Division of Water Quality
Facility Number E� - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint 49 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: O; Departure Time: D County:
Farm Name: ]2e,.e-,4 e1/O/ Owner Email:
Owner Name: rUv V a Phone:
Mailing Address:
Physical Address:
Region: A21f)
Facility Contact: p0.1.-f 4o&7,e Title: Phone:
U
Onsite Representative: Integrator: Ag(Y Other J ��
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
!:arrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[JLaerNon-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)?
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 M No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
CM NA ❑ NE
NA ❑ NE
❑ Yes ❑ No �q NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: iD
ri/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
r] Yes
[)No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 3161 1 l 2`'
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste ARylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
PONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
[] NA
[,B 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? IR
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[ONE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
2] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
F] Yes
❑ No
[] NA
(9 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 [3 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
'E� NE
Page 2 of 3
21412011 Continued

acili Number; jDate of Inspection: b
6
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 14 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[]Yes
[]No ❑ NA M NE
TT
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
7
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 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 MNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
❑ No ❑ NA NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[] No ❑ NA NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.:`
Use drawings of facility,Mbetter,explain situations:(use.additional pages as:necessa ).
s w&-7 c
V -D re-wi&4—
c*J I'S5 �1�5
wr
LZ� �TxaT�G+S ac•I
�r StQ� i��
40
f� Wert- [
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ile"12 -335D
Date: o t // y
21412011

O Division of Water Quality
Facility Number ERN - 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
�P�PI� ■ � r
Date of Visit: 2,/LLI Arrival Time: / Q• a Departure Time: I2r County:
Farm Name:
P{;'Trr'�Owner Email:
Owner Name: N G Put,,,y t Phone:
Mailing Address:
Physical Address:
Facility Contact: IOh ,e %✓�jXyr--� Title:
Onsite Representative: It
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
Latitude:
Region: /=?&
Phone: q/Q`�IS7�Z,S
Integrator: IV L_ f&,_^0 S
Certification Number:
Certification Number:
Design Current Design Current
Capacity. ..Pop. Wet Poultry Capacity Pop,
Layer
Non -La er
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?
Longitude:
Design Current
Cattle Capacity., Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes [] No (0 NA ❑ NE
b, Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ 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 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

r
Facili Numher: - Date of Ins ection: Ide
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 Cy NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3L r Z L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a []Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �] No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
E;3 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?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[�yNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Re up fired 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
[ENE
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
❑ NA
`P NE
❑ Waste Application ❑ Weekly Freeboard [3 Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ WeatherCodeCode
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
[] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
®TT NE
Page 2 of 3
21412011 Continued

' Facili Number: jDate of Inspection: to y
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA [;g 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
53 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?
D Yes ❑ No
❑ NA
[E 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
[�j NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
® NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No
❑ NA
® NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA
[P NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No
❑ NA
� NE
Comments (refer to question #):.Explain'anyYES answers and/or any additional recommendations or any other comments `,
Use drawings of fhellity,to better explain situations (use additional pages as necessary).
4 a eah � Ae., 7—t �,e p n l t'+•wS�� �b12��
(, S wt etll P r)'5 06,2,d ,
r /lqv5-� o �6a--ved we -e— Io- ?-S-Al
A )4d Ce if cr"'epl ALr l s
�J 7 S [ - r wa-S
�6 rl S wa S se eoa `"I -�rur k� .
• rl/0W-tom eh
• Goo �&>-, "/ s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Prlv-,- - r w '2, k'
�✓� Mct. r b le
Phone:
Date: /0 2
21412011

type ul visit: W wmpuance suspecuun v vperauon IVCVIeW V MrUCLUCC GValUallUll V leCnlllCal Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I )1 #'3 Arrival Time: Departure Time: /�� County: MAE— Region: r_AD
Farm Name: eDawly + I Owner Email:
Owner Name: - _X6--ePtwy7� 1;ywS , Phone:
Mailing Address:
Physical Address:
Facility Contact: „`ad' Title:
�f
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
q
Latitude:
Phone:
Integrator: 4ZE R(,.� _ T
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capac..ity
Pop.
Wet Poultry
Capacity
P.
Cattle Capacity Pap.
Wean to Finish
Layer
[Non -Layer
Dai Cow
Dai Calf
Wean to Feeder
Feeder to Finish
Dai Heifer
Farrow to Wean
9Design
Current
Dry Cow
Farrow to Feeder
125Zj
7W
Dr, P,OUItR.
Ca aclt
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharzes and Stream_ Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Ir No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
1 ] NA ❑ NE
1P NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facilit Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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: _ 1 2— 3
Spillway?:
Designed Freeboard (in): rr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑NA ❑NE
8. Do any of the structures lack adequate markers as required by the permit`? ❑ Yes;No
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 Ay lication
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 IM 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
.. CC�rop Window ❑ Evidence of Wind Drill pplication Outside of Approved Area
12. Crop Type(s): C"( e4y d c%asS /Va,t PAA4e- � rl r4r1n
13. Soil Type(s): �QB/ya-b I t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MI 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
T®�
❑ 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 [I 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 TrFfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1P No
❑NA ❑NE
Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

c
Facility Number: - Date of inspection:
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
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
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, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EP 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
Comments`(refer to question #) Explain any YES ansivers and/or.any additional:recommendations or. an
Usc drawings.of:facilifyito better:;ezplaK.Sitti.ations.(use additiondi.pages as necessary) ; _, -
other comments � 4 x':7ti is
4 !1 V_Fi�, _' t
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: if'0_71
Date:
214 011

0 Division of Water Quality
Facility Number - O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: ��o� ,� Departure Time:/,'ao County:
Farm Name: ����p l TLWk^- Owner Email:
Owner Name: / t/i/ Phone:
Mailing Address:
Physical Address:
Facility Contact: j �Dr7-t- Title:
Onsite Representative:
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
Boars
Other
Other
ti
Latitude:
Phone:
Region: /qz
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop. -
La er
Non -La er
ury Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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?
Design Current
Cattle Capacity Pop. .
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �R No ❑ NA ❑ NE
❑ Yes ❑ No Ep 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 j�j No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility'Number: XI - Date of Inspection:
4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
6No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Rg NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identificr: I -3_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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?
r
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 P No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Q 6�(
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
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
P No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�iNo
❑ NA ❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design []Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
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

Facili .Number: - Date of Inspection: 2
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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑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, freeboard problems, over -application)
7`
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
T
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
Nm ments,(refer to question #): E.xplain any YES answers and/or any additional recommendations or any other comments.
e�drawings.of facility to better explain situations (use additional pages as necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ` fQ- 3 �3�D
Date: b
21412011

Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z Arrival Time. Q; Departure Time: r/ County: -ram-
Farm Name:_ A'' Owner Email:
Owner Name: fr'.J'� ""s
Phone:
Mailing Address:
Physical Address:
Facility Contact: � 19 Title: Phone:
Onsite Representative: V Integrator: &,-- P�~�
Certified Operator: U Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: 1-7`U
Design Current;;' ti Design Current: �*^r Design Current
I� ''
Swine Capacity Pop. Wet Poultry Capacity Pop Cattle C paelty Pop.
can to Finish La er'= Daia Cow
can to Feeder "'I lNon-Layer Iw; Dairy Calf
Feeder to Finish�k enK DairyHeifer
y�
Farrow to Wean `P '� Design 3Currt Dry Cow
Farrow to Feeder V I Dr. Youltr. Ca aci PP.,Non-Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers t Beef Feeder
Boars Pullets i, s Beef Brood Cow
Turkeys
Other Turkey Pou Its
Other Other an'
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ 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
0 No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
9No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: t2J - Date of Ins ection: n—
Waste Collection & Treatment
a. 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
Struc7re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
nTt—
Observed Freeboard (in): I�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [qj 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? 7
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 �p No ❑ NA ❑ NE
maintenance or improvement? T
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement'? 1P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes T 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 ❑ Evi ence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6 n
13. Soil Type(s):
l
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[J!�No
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�j No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
CP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EP No
❑ NA
❑ NE
Reauired Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? [f yes, check
❑ Yes
E�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
QNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Tran
fers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;No
[] NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Ins eetion: /
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
15. 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 ❑ No IP 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
No
❑ NA
F] NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [!a No
❑ Yes sp No
❑ Yes 10 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any other comments a;
ilse,`drawing's of facility,to;better explain situations;(use additional pages as necessary). a Fi +' , �.'
Reviewer/Inspector Name: Phone. 7
Reviewer/Inspector Signature: Date: 3 Z'
Page 3 of 3 21412011

Divi"lion of Water Quality
Facility Number E= - S 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 Time: Q ` Departure Time: Q County: (AqV
Farm Name: P'�I��cl—t £ rh Owner Email:
l
Owner Name: T Phone:
Mailing Address:
Physical Address:
Region: PPO
Facility Contact: 1 O n Mwr-e- Title: Phone:
Onsite Representative: �{ Integrator: tkz_ PTVi,5
Certified Operator: ® Certification Number: 1 3D,6
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Des gn
Cur rent
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
3°' S) '' �! i',
Dai Heifer
o Wean
F
Design
Current
D Cow
o FeederE',atilf
,
Ca "ac
['o
Non-Dai
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Othe
Ll
key Poults:3
El Other
Other
I�.hi'iiQIVB'1�3
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes l - No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes ❑ No
❑ Yes $ No
❑ Yes T No
r" NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
J
Page l of 3 21412011 Continued

Facility Number: - Date of Ins ection: /
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 Structure 4 Structure 5
Identifier: I- i— J
® No ❑ NA ❑ NE
l❑�No �NA ONE
Structure 6
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in): t't, 39
'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ 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
[] EvidenceofWind Drift ❑ Application Outside of Approved Area
❑ Outside of Acceptable Cropf1
/�
,w,Window
12. Crop Type(s): �N� C�'rRSS . &-e [ 9-rt�L i LEY _1
13. Soil Type(s): r
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 fo No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
❑ Yes L No
❑ Yes i No
❑NA ❑NE
❑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. 0 Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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 EpNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facill Number: 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 IMLNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M)No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA []NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[P 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
5ANo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R] No
Tp
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #.):..Explain any YES answers and/or any additional recommendations or any other comments lip
U"se-drawings of facility to.better. explain situations (use Additional pages as necessary).
Reviewer/Inspector Name: R4(y, aeb'
Phone:
Reviewer/Inspector Signature: ""
Date: g Ll l
Page 3 of 3
21412011

Type of Visit 0 Compliance 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
Date of Visit: Arrival Time: - -c ti. Departure Time: County: &MF,
Farm Name:_477Pe
f"`-, _ Owner Email:
Owner Name: /1! 6-- PLu vt\S t wry s _%lG/ Phanr-
Mailing Address:
Physical Address:
Region: ><fto
Facility Contact: I" L/lDb_�--P, __Title: Phone No:
'' ,t/6pits✓,S
Onsite Representative: Integrator:
Certified Operator: >rLL Operator Certification Number: g 3b (e
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = 4 =if Longitude: = o = 1 = 1i
Current
qSW�JneVEjCa-ajn3MacjtVopul� t own
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
u
NapaciETRIPoi
Wet Poultry ulation
❑ Layer
❑ Non -Layer
it
mpoult1ly
❑ Layers t
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ 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 Popul
❑ Dairy Cow
❑ Dairy Calf
❑ DairyHeifer
❑ Dr 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?
Page 1 of 3
❑ Yes rNo ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
Ep NA
"ONE
® NA
❑ NE
❑ Yes
❑ No
❑ Yes
(�No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �tNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:— 3
Spillway?:
Designed Freeboard (in):
�` Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [;�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M No ❑ NA FINE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, 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) r,o J V49
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain. any:YES'46s'wers and/or any recommendations or any other comments. .
Use drawings of facility to bctterexplain situations. (use additional pages as necessary):
AL
I
Reviewer/inspector Name 9 Phone: /O
Reviewer/inspector Signature: j2 Date: E 2 0
Page 2 qj'3 12128104 Continued

Facility Numher: t Date of Inspection
Required Records & Documents f r
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ 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 g ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Eff 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 t No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes 4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P 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
IrNo
❑ 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
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�E 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
O 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
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[;a No
❑ NA
❑ NE
Additional Comments and/or;Drawings:
Page 3 of 3 12128104

ghllO JCS
Facility Number
Divisiodof.Water Quality.
Q;:1Dtvtsioa of Soil and Water Conservation
D .Other,Agency
Type of Visit ''Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: —F—' Arrival Time: Departure Time: [7 r :f'yl I County
nn: W?-
Farm Name: l/ dk, &m Owner Email:
Owner Name: N (6 pl/(VlT D ms Trr_ Phone:
Mailing Address:
Region: FkV
Physical Address:
Facility Contact:Title: Phone No: '7
OnsiteRepresentative: Integrator: NCB Pyvir Rootif
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude:
0 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey 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?
Longitude: = ° =' =
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Fleifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 371
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes ti�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
U 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
C'No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'? � Yes
[:]No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pennit? [--]Yes
JRNo
❑ 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
tg�No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
N No
❑ NA ❑ NE
maintenance/improvement'?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
�i-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% or 1 O 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)
If
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
KYcs
❑ 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
R1 No
❑NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
h;-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):
ReviewerlInspector Name �-� ski ref _ Phone: 9ra 933- 3�t 333
Reviewer/Inspector Signature: Date: 3
12/28/04 Candprued

Facility Number: &3 — Date of Inspection ODOR)?
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IRNo ❑ NA [:]NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. CS 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 18 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No CR NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
ER No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
IRYes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
§�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CR NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[SNo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J-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
t'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
RNo
❑ 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
Q-No
❑ NA
❑ NE
...ri4 t T�F :y�r did ',.al �
Additional Comments anWb!i Drawings �,�;- t . °` Ai.m
Ales e, dea, +roe h o4- 0— -OH- 12 001
Qs, a00T sl-tom Svve n6- doi -e,
ivirljt�_cro f nab- maj , No s par6 d ae. Pielk 611 have -good c©Fa, ,
Page 3 of 3 12128104

Facility No. -3-D Farm Name VCf1'[ 1�P(� Date 31,301o2
Permit �� COC OIC NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft& %
Liquid Trt. Zone ft
Calibration Date
1 Vjn-1qj
2
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
3,ro
Actual Width
3 �{
I. WWI
Soil Test Date]
pH Fields
Lime Needed �,4_ 1•�OK
Lime Applied
Cu Zn .✓
Needs P kjD
Crop Yield Y
Wettable Acres
WUP
Weekly Freeboard --�
Rainfall >1" ✓
1 in Inspections
120 min Inspections
Weather Codes --�
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
:.
..��
.
�-_
,r.v I � ii..
OF,
iYMM .,.
r I
�
y.o-$•a
Verify PHONE NUMBERS and affiliations [.03L��I
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

M
.Division of Water Quality
Facility Numb: 'er.; '613ivision,of Soil and Water Conservation
OOther Agency
Type of Visit ')0 Compliance inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit C* Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Accesses f'�
Date of Visit: 0 Arrivai Time: ` M Departure Time: County: l Regio : "-"�-'
Farm Name: 1 Id + OYM Owner Email:
Owner Name:—IAfJ- u - V !.` royM'5 l *1 c/ Phone:
Mailing Address:
Physical Address:
Facility Contact: --T
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
S-A ine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
OV f Title: Phone No: 9 it) dq!�_Tty)LAJ2JW
Y-c_ Integrator: 'Our ViS
Operator Certification Number: Igio
Back-up Certification Number:
Latitude: = u = ' ❑ Longitude: = o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ on-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Urkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
Discharges & Stream Cmnacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge hypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No [� NA
❑ NE
❑ Yes
❑ No _]�JNA
❑ NiE
❑ NoXA1 NA
❑ NE
❑ Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 7� —
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 1 Structure 2 Structure 3 Structure 4
Identifier: 1 Z
Spillway?:
Designed Freeboard (in): b `_ ' (71
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?
[I Yes MNo El NA [I NE
❑ Yes 19 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes] No
❑ Yes No
[I NA ❑NE
El NA El 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?
8. Do any of the stuctures lack adequate markers as required by the permit'?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No
❑ Yes] No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes N No [:1 NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes K] 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 Win ❑ d Drift Application Outside of Area
12. Crop type(s) �Q, � I//' -^ 9y) Cyr 0
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
X[No
❑ 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
RNo
❑ NA
[I NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
V .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):
�tklp l S d1 & 6v`s .
ern Cross a .
Reviewer/Inspector Name G
sritiL=-- AL4 �Jro
Phone:11/ 1
Reviewer/Inspector Signature:
Date:
12128104 Continued

L
Facility Number:& 3 :Z Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes �,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [R No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No CJJ�NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
D�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[A NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
r
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J�tNo
❑ NA
❑ NE
12128104

Facility No. Time In Time Out Date
Farm Name rv^
Owner 4 <51vt`
Operator
Back-up
Integrator t-�uY�V I S
Site Rep
No. t
No.
COC Circle: Gener or NPDES
Design
Current
Desi n
Current
Wean — feed
Farrow — F6@0
V b
Wean — Finish
Farrow — T Inish
Feed — Finish
Gilts / Boars
Farrow -- Wean
Others
FREEBOARD: Design / $ -'
Sludge Survey
Observed lg r
Calibration/GPM cl0 1
Crop Yield Waste Transfers
Rain Gauge Rain Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop r
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
WO J
tr �q
Date Nitrogen (N)
t.3
131 z-1
Pull/Field Soil Crop Pan Window
' D
r r

(Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Z Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: Departure Time: 00 1 County: Region: F
\t, l C� Owner Email:
Owner Name: N a 4 LA_ ry 1 , ciC YM S___ ___ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 Of) lMl Title: CA) U
Onsite Representative:C O
Certified Operator: � eAA to
c
Back-up Operator:
Integrator:
Phone No:
_YV 1� S
Operator Certification Number:
Back-up Certification Number:
40
Location of Farm: Latitude: ❑e 0$ =4 Longitude: =o =, =
11
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C►apacity Population
Cattle Capacity Population
inish
❑ Layer
Dairy Cow
eeder
❑ Non -La er
❑ Dais Calf
Finish
FFarrow
❑ Dair Heifer
Wean
Dry Poultry
❑ Dry Cow
rjKarrow to Feeder 7-5 :Z .
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Eli_ BeeFeeder
El Boars
❑ Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other I
er 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
A
tA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ElNo
❑ 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
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
yvM
M No
❑ NA
❑ NE
other than from a discharge?
Page 1 pf3
12128104
Continued

'Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
SpillwayT
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
i f(
❑ Yes (�No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
*A ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 45No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes NNo ❑ 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 �gNo ❑ NA ❑ NE
8. Do any of the stuctures 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 14No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1�(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes INo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑Application Outside of Area
ce
12. Crop type(s) L _ . _;:we_ GVC%_' 411, LI,S
1 � ,
13. Soil type(s) �0— E> t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes b+No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes �9 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 nNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendatlons or any other; comments
Use drawings of facility to better explain situations. (use additional pages its necessary): <v
��SQ �urrrx�� iA-) r
M 5 a,4 ca C'A aw �,�a
S�Rsvr�
Reviewer/Inspector Name WfL;" ;�, a e ;Phone: r `f 33 ^3�,3,,,�
Reviewer/inspector Signature: Date:
Page 2 of J lL/Ld/U4 [..onnnuea

Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'XNo ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
1P
❑ NA
❑ NE
the appropriate box. ❑ WUP ElChecklists ElDesign ElMaps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
-);Vqo
❑ 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
'19No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
&A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PVo
❑ 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
�i No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A 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
No ElNA ElNE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the faciiity pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
)!)No ❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA ❑ NE
Additional:. Comments: and/or' Drawings:.
0-7
1
Page 3 of 3 12128104

o
Facility No. V Time In Time Out
Farm Name C)_Q 0 A A-. .%C Integrator
Date 711
Owner Site Rep Qc
Operator KriQ r No.
Back-up No.
COC Circle: 4ener or NPDES
Design
Current
Design
Current
Wean — Feed
arrow — F
�.
Wean -- Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boars
Farrow — Wean
Others
F . EEBOARD esign
Sludge Sur
Crop ield Waste Transfers
Rain Breaker
Wettable Acres
Rain Gauge
Soil Test - PLAT
Observed
Calibration/GPM 1
Weekly Freeboard V Daily Rainfall 1,z 1-in Inspections
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
(3,
0, 2
Date Nitrogen (N)
Pull/Field
Soil
Crop
Pan
Window
f%

t
Type of Visit t�ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: ArrivallTTime: It ; Do
Departure Time: 3 County: M dDr-e
Farm Name: 2E�r >rL�i >�c►✓n-t--- Owner Email:
Owner Name: -viil i 6r✓r?_?-3 Phone:
Mailing Address:
Physical Address:
Region: E&D
Facility Contact: Zf?�f 410=- Title: Phone No: d,76-- %6
Onsite Representative: -_-_ pr-_f ___ _ _ Integrator:
Certified Operator: �_l; -r- Operator Certification Number: _1,5;`:� 06
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 1 Longitude: = o= 4
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La et
❑ Feeder to Finish
Farrow to -We". Dry Poultry
Farrow to Feeder Id 12oo
ElFarrow to Finish I ❑ Layers
❑ Gilts ; ❑ Non -Layers
❑ Boars ❑ Pullets
- .._. - ❑ Turke s
Other: ❑ Turkey Pouets
❑ Other ❑ Other
Discharges Sr 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 Stockei
❑
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 ;U No ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
E� No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
RNo
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
(4;No
❑ NA
❑ NE
12128104 Continued

5
r �
Facility Number: &3 — C)7 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ULNo ❑ NA ❑ NE
the appropirate box. ❑ WUP
❑ Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking WropYield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
K No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
W No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
rM, No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
X 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
A 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
9 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JL No
❑ NA
❑ NE
09 ). KI- e,,pC1>rVF � eld
12128104

L
Facility Number: 3 — Q
Date of Inspection —0tv
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: k J'L 7'
Spillway?: YES _yrs X's
Designed Freeboard (in): 7 y
Observed Freeboard (in): /6-, ez
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 0 No
❑ Yes QdNo
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
❑ Yes JV No ❑ NA ❑ NE
❑ Yes 21 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 LP No ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fip 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 stnuctures require ❑ Yes MNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R[No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, 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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) �c
13. Soil type(s) Ear• D 1 Z,4 7?
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes WNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:❑ Yes JRNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes M No El NA ❑ NE
❑ Yes Q.No ❑ NA ❑ NE
����''� �
Comments (refer to questiun!#} Explain any YES answers and/oranyirecnmmendations or aqy other comments.
'?4Fi' 1s r'a ndf
Use drawings of facility toFhetter explain situations'{useadditlona! pages,aslnecessary}:
Reviewer/inspector Name - ` "' A _,F ' °_< Phone:
Reviewer/Inspector Signature: Date: — ;7--Q (r
12128104 Continued

er
-: ,. "`.1 ' i'i'sii "�f ii 1 --EI[7l;i!PI NIP - -,'I i3l�lraif ?' fi , t i" !vifi..,tfSs'fa-�. t iy t . :1 „ i.
<.if iff 11 .I f'.�, • ii,..! Eif•i.'3 ! III s:}.. ,:F= �i' ,'- ii ?}l-Y'. i �g i} }i� - f. I �' i'. iK` i i I Y ! I
•�,!Y��N " �il .�eF� i I� siF `i,� � EIS � - � .�: �
Drvrsta�n qfE Water : matt i i "0" >r�:
is �i.
'.'IaIC.i��ip�ENlf�',r��i� �,
}Y Y IF I.�F! i9ft ! Fi.za.}�11„
saon�of sgil snd watergg,Conservaaoih i;,r i}[ry��I,E 1 j,{I,,;, ,
�
i i�! Ei,i S
�
+� 1 !'
! i , ,'liI{,?
'a'rEE�•ef, 1'« t
4tatE.lilll t I 1 f I;rI,R
, . }1 j {4�? Ii, �i..,, i -�l�l.fiA ♦lf.r. 1 iE'bii- E
:�. �{ � il�•uE Ii -.ii{! €� � Eii�'`�kS it� {I�'
�i..t �.ll
.!� 1
j !�
=ii iS § :.1 °i; i ili 1 l „
jjj
t1f
t
i4,}!filg,Fi i,{ fis-t'- j[,3l1? , a,.l. ?}' {
..pia, i_al:.i,i.3 fi �,qa-._i_.' .i 611ff ! Ei. ..lri.,. l,ati' .Eif'i�R.e: it:.•: iE...r.tti ti.'i I�i.��Xl!1..�ivE� 1 .-.��ii.f.v L4jj . ��s i(�ij'�i-�`,�ijii�l�i,Iii� 11�;1fI1 r.1i- ...1 d�61... Ei.- i•.:iEl.� ,ice>.ii.1 <i�
1i'.•.E tE�h�': _ii .3FlI Fl�1 I :I
IEi:I. >Fi�:i.- .i{'.f NE ..{: j 4{y��
"type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
J
Date of visit: 1 �O_OS� Time:
Facility Number 3 �7
Q Not Operational C Below Threshold
Permitted © Certified 0 Conditionally Certified C[ Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...........4 a ''.. .•. c `aQ.......... rrsx m............................................. County: .......... r?ap.P. rs...............................sF Q.. .
Owner Name: ................ 111`11.G............................... e r_n '................ Phone No:....... ..... .1. .'.. ..........................9 7...
Mailing Address:..... PS Y....... e........ F. A ....... ......... lv.0.... ....... .............................................. ..? .731..i
FacilityContact: ....... Title:................................................................ Phone No:...................................................
Onsite Representative: ............ AU-f.4fx.r............ Esy.�. .................................... Integrator:........I.V..a ........ ...................
..............
Certified Operator: •,,.••,.•,.••„•,•,.„......•...•„•••...•......... .... Operator Certification Number:
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 " Longitude • 6 41
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes YN 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 DWQ) 0 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 & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
........ .................... ............ ......./ .....,.......................................................................................................................................
Freeboard (inches): J 'f
12112103 Continued

Facility Number. &,5 —
Date of Inspection ^ I n^a
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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?
3yaste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [:]'No
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? []Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
P No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
6+6 V- v+ Sa 5 0.0'U C 1% ee_l-� s
Reviewer/inspector Name I -
Reviewer/inspector Signature:
Field Copy ❑ Final Notes
Date:
05103101 ZV Continued

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit *Routine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date (11,Visit: 3 rl Time: 0 `
ro Not Operational 0 Below Threshold
® Permitted ® Certified r] Conditionally Certified ❑ Registered pate Last Operated or Above Threshold:
Farm Name: _ .�ecr-F-t 6A h'C�l�ry� - -_- County- M
Owner Name: — ltii -_. loyrU is Phone No: 1 0 $ -Aa3-4-
1►tailinc Address: _ 5 a4- n 'r tr L' , as
Facility Contact: _1�O vn , 1Ni Oo,M Title: Phone No:
Onsite Representative: t o Y, u 0 M Integrator:. i_4AL4fi <
Certified Operator: - lr04_i.Q - r Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° 0" Longitude • �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder I ❑ Laver I I 1 10 Dairy
❑ Feeder to Finish 1 10 Non -Laver I I ILI Non -Dairy
❑ Farrow to Wean
® Farrow• to Feeder -6 ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Subsurface Drains Present
Discharges & 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, 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 8 Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ® Spillway ❑ Yes [RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 4- C
05103101 l / C' Continued

Facility Number: (,,3 — Date of Inspection)
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JBNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type 13 e'r"' v- ckr_ - --1­ O
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
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[SNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[� No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[� No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(icl discharge, freeboard problems, over application)
23.
Did Reviewcrllnspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�4„�•ar� a k+� tmtilr4�aw� � _ � a
Comments to #}: Explain YES antl/p reepmmendations `nrra�y,other
(ieffr question any answers ny, comments.
z s � y-
` g ty p ( s s necessary} 4.
lse.drawin" sr .00eili. to better ex Irvin situations; use additional�pages 11s ssU
�. , .: � ❑Field Copy ❑Fin, l Notes
.
Cab-�
Reviewer/inspector Name "
Reviewer/[nspector Signature: Date: qo
05103101 Continued

Facility lumber: &3 — Date of Inspection 3 ,
or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[3 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
allo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
-AdditionaTGomments andlar;Drawings:.... s
05103101

Site Requires Immediate Attention:
Facility No. w3 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner: Al-5-
Mailing Address:z,,:Ee�
County:
Integrator:
On Site Representative:.
Physical Address/Location:
DATE: 7 2,P , 1995
Time: //•'�9 �- //•"37
V
97
Type of Operation: Swine 3' Poultry Cattle
Design Capacity:/ eP%s w-4w - y Number of Animals on Site; z�w ,tiJ i
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0 ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)®or No Actual Freeboard:--i 23 Ft. I hes
Was any seepage observed from the pn(s)? Yes oi� Was any erosion observed? a or No
Is adequate land available for spray?orNo Is the cover crop adequate? �or No
Crop(s) being utilized: K—FR
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? r No
100 Feet from Wells? drs)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ozff�'
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ord9D
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar mars -made devices? Yes oR!f;5:) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ocl5o)
Additional Comments: v- 4A9V'W1 ,-.a ae_—
Pr?,6rP�5_A17' 4?e,9o1A&1 -
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

V•

DEERFIELD FARM
N.G. PURVIS FARMS
SWINE Hill �i(�F

8" PVC OUTFLOW PIPE
INV. EL. = 87.49'
RENICHMA.RK
TOP 0�_ Cf)NCRETE FOUNDATION
EL = 1`1i1 GO I ASSUMECD1
0 I(
Y
1
�� II
LAGOON NO. 2
SURFACE AREA v 38,538 SO. FT.
'
(AT OVERFLOW EL. - 83.95) ' �-1
i h
\• rr'
j1
1
8,. 1„�C OUTFLOW PIPE 1 ,
}_ T TTR --- NO -2---- -- INV. EL = 81.19r- 1I 1
NAS E LAMENT LAGOON
ELEVA D r�
CUBIC YARDS
i
CUBIC FEET � �LLONS
4 83 95(OVEP.FLOvv EL }
934_4.87
CY
25231 1.49 187421.01
_--- --
5245
7288.55
C-r
196790.85 -�-;
4 .'2097.79
81_191o(TF.' ,v tr >> E
5693.39
CY
15 721.53
,+-�
1 ^ 9916.90
3633.23
.258 73
-t
C'Y
c r
u i9.4s
t 78 95
--
99447.21
L8. 9 .7
/43916,79
658,
WASTE TREATMENT LAGOON
SURVEY FOR:
N. G. PURVIS FARMS, INC.
DEEhFIELD FARM
BENSALEM, TOWNSHIP, MOORE COUNTY
NORTH CAROLINA
OCTOBER 15, 1996
0 J 50 150
P _%_ -
I)o ft
A
B
C
0
E
WASTE TREAMENT LAGOON NO.
ELEVATION CUBIC YARDS CUBIC . FEET
89.65(QVERFLOW EL.) 15479-28 CY
1
C AELONS
aa.�$
12543.01 CY
338661.27,
2533362.23
87.47(OUTFLOW INV. EL.)
11 277:92 CY
SO4503.84
2' 7?846.91
85_15
7344.92 CY
198312.84-
1433483:06
84.65
Y
17-6829,75
1322778.39
z4 ,LNr vo,.7 3 AA,S s"`wk1
1t E
r!
;
r
�4
ffJ
•i1r f
l
� �
-
A
C
D
LAGOON NO. 3
�rI SURFACE AREA = 89,505 SQ. FT. f
(AT nvF4Fr n,r, c2 = fip -7Qri
WASTE TREAMENT LAGOON NO. 3
ELEVATION i
63.74(OVERFLOw EL %
0_)Pk�_: YARDS
30761.75 CY
2936.55 CY
CUBIC FEET
830567.25
GAL_GN'S
621_074 49
0026-85-
�i.24 509.42 '
65 24
19907.01 CY
537489.27
4020698.95
�63.24 - - --
15966.62 CY
431098.74
32 J1842.52�
,...,,,, 1 1111, i,,..