770001_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
II

(Type of Visit: O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: 2j;', Arrival Time: 0 Departure Time: to County:
Farm Name: C �^ Owner Email:
Owner Name: kJ4 &,-c ,, ` s Phone:
Mailing Address:
Physical Address:
I v�+�Region: l�
Facility Contact: /Yfc�✓��e:.,�T- Title: Phone: Onsite Representative: _ Integrator: NG 1 {� CL � i.3
Certified Operator: t" Certification Number: 100 131_3
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
f�ti�
ia�illil�y
Design Current
Design
Current
iDeslgn
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cam !e
Capacity
Plop.
Finish
Layer
DairyCow
Feeder
Non -La er
DairyCalf
o Finish
Dairy[leifer
o Wean
Design
Current
D Cow
o Feeder
EFd
Dr Poultr
Ca �acit�
1'0
Non -Dairy
o Finish
La ers
Bef Stocker
Non -La ers
Beef Feeder
Pullets
I Beef Brood Cow
Turke s
OtherA
-urkey Poults
OF Other
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ 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
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
iNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 . A Z r 21412015 Continued

Facility Number: Date of Inspection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IF No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes T❑ No P] NA ❑ NE
Structure I 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 No ❑ NA ❑ N E
(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 jP No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes §Q 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 T 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 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 off Wind Drift ❑ �AppHicatipn30pt�jde ofA roved Area
12. Crop Type(s): f �C `-' ii_I I,I� sit"aka ���
13. Soil Type(s): 13qd.4 i, r; �e ak,41 6
1
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
Q� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[5d 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 [)j�N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections El 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
o ❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 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
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
❑ 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:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 Of 3
Phone: /V —135 3�
Date: % / 9
21412015

lReason for Visit: ® Routine
O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f l Arrival Time: Departure Time: /Q' County: J2F-CA0f60yj1 Region:
Farm Name: G Owner Email:
Owner Name: V D �'j ►t G' + �( �t Phone:
Mailing Address:
Physical Address:
Facility Contact:
y
Onsite Representative:
Certified Operator: U
Back-up Operator:
Title:
Location of Farm: Latitude:
Phone:
Integrator: 06- PL(1%/tS
Certification Number: %W %3 f 3
Certification Number:
Longitude:
Crrent
Design11",
Design
Current
Design Current
Swine Capaciop,
Wet Poultry
Capacity
Pop.
Cettie Capacity Pop.
Wean to Finish
Layer
DairyCow
3:
Wean to Feeder
IFIDairy
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
P.
—Dry
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ZNo DNA ❑NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes Ll No
�NA ❑NE
® NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page '1 of 3 21412015 Continued

Faclli Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier:
Structure 3 Structure 4 Structure 5
J
P§ No ❑ NA ❑ NE
❑No NNA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
y
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental
threat,
notify 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
J�j No
[DNA
❑ 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 C� 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 Driftp ❑ Apppllica ' n Outsi a of Ap ove Area
12. Crop Type(s): tr,�SCtt e le�q$ '� 1�1�—� Gt � hQ <c� � r'�
13. Soil Type(s):
14. Do the receiving crops differ from those designate(I in the CAWMP?
❑ Yes
K,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
JK] 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 F No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
T ''
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number: Z7 JDate of Inspection:
24. Did the facility fail to;calibrate waste application equipment as required by the permi . ❑ Yes Do No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes R2 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D 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
C8 No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
Appl' aat_ion 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 Pa No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
)a No
❑ NA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
bDNo
❑ NA
❑ NE
(Comments (refer to questlon#) Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better expliiin situgtions (use additional pages as necessary).
�Po L44 /qa,�� - 0 ua
919-62`(- 4loul ceebo
Reviewer/Inspector Name: 111)b lekt
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: % Z-7
11
21412011

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 0 Departure Time: County: Rr C14A p}f 9 Region: �'�
Farm Name: oC l Vh Owner Email:
Owner Name: W I a sMS Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone: Ito — 2D6-6VY
Onsite Representative: u Integrator: IS
Certified Operator: Certification Number: I 0 13 13
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
@urrent
Design
C►urrent
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
P.
Cattle
Capacity Ppp.
Wean to Finish
Dai Cow
Wean to Feeder
LELayer
Non -La er
Dai Calf
Feeder to Finish
f�
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P,oultr.
Ca aci
Pp
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
urkvy Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 �z No ❑ NA ❑ NE
[]Yes [:]No
❑ Yes ❑ No
NA ❑ NE
NA ❑ NE
❑ Yes
❑ No
r7Q NA
❑ NE
❑ Yes
�jNo
❑ NA
❑ NE
❑ Yes
;R No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facility Number: IDate 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: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):3 u
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
M 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
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
5@ 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
[P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or tO lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable CroA Window Evidence of Wind Drift ❑ Application Outpideipf
Approved
Area
12. Crop Type(s): Z (Ili ems-k A 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
[0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes q3 No ❑ 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 ❑ 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 1
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Apptication 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 reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
ainany�YE5an;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �a No ❑ NA ❑ NE
E] Yes [Z�No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes �&] No
❑ Yes No
❑ Yes No
i
❑NA ❑NE
❑ NA ❑ NE
[3 NA ❑NE
Phone: -I 10 -1(3 3
Date: sh Y�11:0
21412014

q
Division of Water Quality
Facility Number 1 ► !.J - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 4D 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 0 Denied Access
Date of Visit: Arrival Time: n•.. Departure T ime: 3 Q County: C r w Region: PLD
Farm Name: _qe Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: Yy
Facility Contact: Ohh f`l�iQ�M Title: Phone:
Y
Onsite Representative: �, r Integrator: _(S/% iµr✓ f
Certified Operator: N Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish p0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Non-L;
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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
❑ Yes ❑ No
MNA ❑NE
1PNA ❑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 P No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes Ep No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili 'Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EP No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
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) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes §g 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the'CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�g 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
KM No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�] No
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1W No ❑ NA [3 NE
Page 2 of 3 21412011 Continued

Facility umber: - 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 SbNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to proper] y. 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 K No ❑ NA ❑ NE
❑ Yes tZ No ❑ NA ❑ NE
❑ Yes "�L No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature: Date: 3 /
Page 3 of 3 21412011

i
Division of Water Quality
Facility Number ' 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Revlew 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
r
4
Date of Visit: 3 I I o Arrival ime: aQ Departure Time: County: P_C)"61 Region:
r.
Farm Name: e '"'� Owner Email:
Owner Name: �h kAt Phone:
Mailing Address:
Physical Address:
Facility Contact: J-0V KV"I �1 a f [ �itn�S Title:
Onsite Representative: k
Certified Operator:
Back-up Operator:
Location of Farm:
i
0
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 7,GZ7
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Phone No:
Integrator: __ Nt� PfA.t' J t S
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= f Longitude: 0 0 0
Design Current
Wet Poultry Capacity Population Cattle
❑ La er
❑ Non -Layer I EE11
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Daia Cow
❑ Dairy Calf
EJDairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes ❑ No (R NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No R NA
❑ NE
❑ Yes F No ❑ NA
❑ NE
❑ Yes 1� No ❑ NA
❑ NE
Page I of 3
12128104 Continued

FaciPity Number: — 1 Date of Inspection II I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes k No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 tructure 6
Identifier: 3-71
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F
No ❑ NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes V 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 ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
I. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
OD 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
JP No
❑ NA
❑ NE
s z t
Comments (refer,to'.question, #) , Explain any YES'answers and/or any, recommendations or any other comments
se drawfacility to>bette'r explain situations: (use additional pages as,necessary)
Reviewer/Inspector Name " °.'fi r'' , "�:ta,f h� Phone: ' {D " — 3 300
Reviewer/Inspector Signature: Date: 4
Page 2 of rerFr."V"

~' Facility Number: — Date of Inspection
Required Records & Documents JJJ
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. [] WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[PLNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
EJ1No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
BNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
09 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
0 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
Q9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
§L-LNo
❑ NA
❑ NE
Additional Comments and/or Drawings:�:'1"
Page 3 of 3 12128104
Page 3 of 3 12128104

type of visit: w Lompuance inspection v taperanon xeview V structure Gvaivanon u tecnmcat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency t) Other 0 Denied Access
Date of Visit: I Arrival Time: 4Sb Departure Time: p ;,1r0 County: RE96M6MP Region:
Farm Name: joclk--
�d e , Owner Email:
t 1j
Owner Name: h A%4 S� liiJ�/Q p� C. Phone:
Mailing Address:
Physical Address:
Facility Contact: �0��„� �,, c.JI��I �Gf C Title:
Onsite Representative: u
4
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Al G F6,45
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Finish -
La er
DairyCow
We Feeder
JHEFeederttto
Non -La er
DairyCalf
Finish
o
2
Dai Heifer
o Wean
Design
Current
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nvn-La ers
Beef Fceder
Boars
Pullets
Beef Broad Cow
Turke s
Other
Turk Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes �g No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ 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)? TT
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 T1n[+� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

acili Number: Date of Inspection: \
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
Q9 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?
❑ Yes
[gg 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
0 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�g No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A
12. Crop Type(s):
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
[jg 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
6;j 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 property 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 P 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 Q@ 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 21412011 Continued

Facility Number: - Date of Inspection: t It
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 compliancc 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
�i] 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
[VU 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
F] 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 answers and/or any additional recommendations or.any other.comments.. ,
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name::-
Reviewer/Inspector Signature
Page 3 of 3
Phone: [phone]V
Date: + t l.7
21412011

rp—
• Division of Water Quality '
�- Facility Number ©- O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit: • Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: j 12. Arrival Time: .0 Departure Time: j%0 dk County: FZ01M&-Aegion: t—'(1 V
Farm Name: 'j�nGlLu l�414::Ze r1tryV1 Owner Email:
Owner Name: TO rtv%!4 5 � I I'L1nS Phone: g11)"Z0(7t* cn (c) -_
Mailing Address:
Physical Address:
Facility Contact:
J UhWXr\ -i h-$ Title:
►4
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
0
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
'
Feeder to Finish
W
Farrow to Wean
Farrow to Feeder
Farrow to Finish .
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: Obi— Pu„rJiS
Certification Number: % 16
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
u ry ro
Layers
Non -La
Pullets
Turkey,
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:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
Non -Dairy
Beei'Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P] No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes MNNo 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

Facility Number: - Date of Inspection: 1 I aX
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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑No ®NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -58
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Cj� No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [P No ❑ NA ❑ NE
waste management or closure plan? TT
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 �4 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 V No [3NA [] 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): FescuQ[ t "94 t). &_w,.-J6-kQt4e &" I. P&�_� tM)Y`' , (C%ltZ 1 0i��
13. Soil Type(s): T30t101 , J01CL4_ri _ r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ep 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
r7l No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
q No
❑ NA
❑ NE
the appropriate box.
TT
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1� 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 Qg 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 21412011 Continued

F'acilit Number: - Date of Ins eetion:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes P No NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [P 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 V9 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 CAWMP? ❑ Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesP No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes MINo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other can�ments. '•
Use drawings of facility to better explain situations (use' additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ph % 7 a
Date: 1U—L0 -_UU
21412011

Division of Water Quality
I.Facillity Number Q Division of Soil and Water. Conservation
- — - - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint Q Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: W .`9Oct Departure Time: i !+1 1 County: ` Md�i7 Region:
Farm Name: i���lf'tn A�Ae_ r-a'y- ► Owner Email:
t
Owner Name: 14,, S Phone:
Mailing Address:
Physical Address:
Facility Contact: - �hr.� _01 � AAS Title:
Onsite Representative: me L SW-J
Certified Operator: tj ° {
Back-up Operator:
Location of Farm:
Latitude:
n°
Phone No:
Integrator: pw✓Vlis
Operator Certification Number:
Back-up Certification Number:
Longitude: = ° =' =
F Design '"Current' Design. Current,'.'':.'Design Current '"
Swine Capacity Population Wet Poultry Capacity Population: Cattle;Capacity:, Population',
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
3 aD
` 6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
I
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
t
❑ Turkey Poults i.
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ D iry Cow
❑ Dairy Calf
❑ Dairy Heifer
EIDEZCow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
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 T No ❑ NA ❑ NE
❑ Yes ❑ No q9 NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
12128104 Continued

W_ %
Facility Number: —
Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. 1f yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 ❑ NA ❑ NE
❑ Yes ❑ No [�JNA ❑ NE
Structure 5 Structure 6
❑ Yes �No [I NA ❑ NE
❑ Yes 1� 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 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
i
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift jj ❑ Application ,,11Outside of Area � �Cp v-n IC��jI{a� '11
12. Crop type(s) rese"LE--h�f'4S *-��,-�-r da Lf'fa 41 rRS'�J, 5., r , GN�r'La ,
13.
Soil e Y�
type(s) (s) ?Ok ^ . Ul, ��i ��11
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[No
❑ NA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
ElYes
((� No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
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):::
0
Reviewer/Inspector Name 40 Phone: 91a�� 3 - 33GYa
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Y r
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �1No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C�LNo ❑ NA ❑ NE
the appropriate box. ❑ WDp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No El NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
tNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
29 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�L`No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
*o
❑ 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
[INA
ElNE
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
0 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
Comments and/or
Page 3 of 3 12178104

Type of Visit 4P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1Arrival Time: Departure'rime: !(1i County: Region:
Farm Name: _— R.I- _��gC� f MMr►^^ _ Owner Email:
Owner Name: `� ���h`'I �t f �ta5 Phone:
Mailing Address:
Physical Address:
Facility Contact: J 0 Ylyt 6); �1 Qrv,5 Title:
v
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: ✓i�
Operator Certification Dumber: 176 �I
Back-up Certification Number:
Latitude: = c = 6 = Longitude: = o = , = 11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 300
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of -the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: 1E
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 fpNo ❑ NA ❑ NE
❑ Yes
❑ No
ERNA
❑ NE
El Yes
❑No
1PNA
❑NE
n NA
❑ NE
El Yes
[I No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
1l•2U..tic.w., .lc.f,
12128104 Continued

r't �
Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
q 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): oZ 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IT No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
T 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
1P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
TPNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ElNE
maintenance/improvement?
4
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
%}No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�j No
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
t.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RlNo
❑ NA
❑ NE
Comments (referTto qu"estlon}#j Explainpany YES answers;and/orfanyfireeonlin Lions{or any other comments.
Use dray ngsnt`ifacllity. to better explaip�situ"�tlons (use additional, pas sass necessary,). 1
Reviewer/Inspector Name Phone: �10�3�-33t]o
ReviewerlInspector Signature: Date: -2 -iR D9
121,28104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes §Q No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /11 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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tNo
❑ 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
IS No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
OgNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C9 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
KNo
❑ 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)
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
NNo
❑ NA
❑ NE
Additiunal Comments. and/or Drawings;
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fpllow up 0 Referral 0 Emergency 0 Other ❑ Denled Access
Date of Visit: Arrival Timed© Departure Time: ® County: a Region: r90
Farm Name: -- P R+'" x Owner Email:
Owner Name: sio�tti►1y Sr wr f r�5 Phone:
Mailing Address:
Physical Address:
Facility Contact: J 04t'" Gj i f I ram S Title: Phone No:
Onsite Representative: If Integrator: —Vg pu rvis
1
Certified Operator: Operator Certification Number: J?6SzT
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 =' 0" Longitude: =° =' 0
Gt7o rE `�"'•„�� f NC
Design Current' x� s. Desgn�,Currenesign CurrSwine �' Wet P'' ��Capacity Population "� }oultr�y Capacity �Populahon Cattlea..T.'fi•.vtrG `Ar _J.... F5r.ar.s.esmer...
❑ Wean to Finish ❑ La er ❑ DairyCow
❑ Wean to Feeder ❑ Non -La er ❑Dai Calf
Feeder to Finish %r ❑ Dairy Heifei
Farrow to Wean ' F ''+ ❑ D Cow
Dry Poultry a
❑ Farrow to Feeder
❑Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
El Gilts ❑Non -La Non -Layers ❑ Beef Feeder
❑ Boars ❑Pullets ❑ Beef Brood Cow
�k� ' ❑ Turke sr F
Other �� w �s. ❑ TurkeyPoults`` t,
❑ Other 1�
❑ Other Number°of Structures:
LIJ
- .;2..c'�.li' ..�''an'"-tn:F'�...., .. !i�'..aS.`^:.�•'�x'�?f;:9 ae�11r�..1 b.,.: .s�se,1''
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
(�No
ll
❑ NA
[I NE
Discharge originated at: ❑ Structure ❑ Application Field El 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
V NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
qjNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: r(`j — Date of Inspection l /
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
LP 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
n 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
6No ❑ NA
❑ NE
8. Do any of the stuctures 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside off Acceptable Crop Window ❑ Evidence of Wind/Drift El Application Outside of Area
M
12. Crop type(s) i'4etxP (tit�r�fQS� �ilShi.c�t5f���. i7rr� 1 !'K1�rt C��
13. Soil type(s) A, C' K
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tp No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
6No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZI No
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
9No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone: ID J-330a
I
Reviewer/inspector Signature: Date: % OS
12128104 Continued

Facility Number: =Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes figNo ❑ NA ❑ NE
the appropirate box. D WUP ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9LNo ❑ 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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
P Yes
&❑
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
ZPNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PSNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;KPNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
D Yes
W 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
[R 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
CK 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
!onY 1460re - /1 plwrviS 11a5 �2¢,vt co tc o� Sege-j 41 is
;0,,-rnPX
"me"i'v `
a s sP og,`4
AwdS J ca&
U� � I� � � � �ow -� � c�2c-� �a1� � r� b�►
12128104

N
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit IbRoutine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I e2 Arrival Time: Departure Time: 1 /4, OQ am County: J411
Farm Name:
Owner Email:
Owner Name: To 1' n+ 4 tj I II In MS Phone:
Mailing Address:
Physical Address: I
Facility Contact: to k"� �' �r l a M5 Title:
Onsite Representative: Gj
Certified Operator:
Back-up Operator:
N
Region:
Phone No:
integrator: . ,iG— P%tnr IS
Operator Certification Number: 1 7( i
Back-up Certification Number:
Location of Farm: Latitude: a o =' [=] Longitude: = ° =' =
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population
@attic Capacity Population
❑ Wean to Finish
1110 Layer
❑ Dairy Cow
I❑ Wean to Feeder
10 Non -Layer
1
❑ Dairy Calf
❑ Dairy Heifer
S Feeder to Finish
?NCO
3
to Wean
❑ Farrow11
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La ers
110
El Beef Stocker
Gilts Non -La ers
❑Beef Feeder
❑ Aullets
PO Boars
❑ Beef Brood Cow
❑ Turke s
Other ❑ TurkeX Poults
❑ Other ❑ Other
Number of Structures:®
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
[4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CE No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
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
Jn No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
%NA
❑ NE
Struct 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier, 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �dZ
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
CONo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;K No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C@ 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 W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 93 No ❑ NA ❑ NE
maintenance/improvement?
1. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
DU No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
50 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V 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
Commcuts (refer to question #): Explain any YES 'answer s and/or any,recommendations or any other comments
°Use drawings of facil€tyto better explain situations. (use additional pages as necessary): .
a
r
Reviewer/Inspector Name - - — -f — _ - — - 1 Phone: /
Reviewer/Inspector Signature Date: Zy1Ar%
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Codc
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�INo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
ElNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
19 Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M 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
)9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1$ 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
W No
❑ NA
❑ NE
General Permit? (ic/ 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
EJ,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
l 1 ]'A
aMIrCA on �,Lu�rv1� CRIha_A0n MuS� AZ d0tw
Tn %*e9re -�;vm 1V& fow-✓i'S W05 Cork '--4b V do
- IIY D,j we `� l-
t'('
A
Page 3 of 3 12128104

(Type of Visit 61,Zoutine
pliance Inspectlon O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 Arrival Time: ® Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Phvsical Address:
Facility Contact: Intl
( ) Title:
Onsite Representative: �O 1 h Yl ll1 W") Wilyl
Certified Operator: O+ n "t/ y 1 !t Q n'45
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: E'
Location of Farm: Latitude: = o = g = Longitude: = ° = 6 =
DesignIciPrent
Design
Capacitypulation
Wet Poultry Capacity Population
A.CurrentDesigSwine
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
W-feeder to Finish &O
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
El Turkey Poults
❑ Other
❑ Other
NumlJer of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�lo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
[]Yes
❑ No
A
ElNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[IYes
❑ No
A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
�kNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Nurilber:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): f �
Observed Freeboard (in): Zo =Z!
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 'XNo ❑ NA ❑ NE
❑ Yes &No R ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 'KNo ❑ NA ❑ NE
❑ Yes Vo ❑ 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 �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require []Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes*o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 o
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �I o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
S-rr Uc. llt
ail
Reviewer/Inspector Name I --- CAkt6l— -- I Phonc: /d �7
Reviewer/Inspector Signature: Date:
Page 2 of 3 Q�28/ilk Continued

Facility NutAber:-7 Date of Inspection
Reauired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes �No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes N ;
❑ NA
El NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes *No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes IVo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 71No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
❑ NA `ONE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 'IXNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes §kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 51�110
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes -Io
❑ 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)
32.
Did Rev iewerllnspector 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
Addltliinal'.Cotnment°:and /or Drawings,
x1_1C0_1t&V& reCQ Y01e W carn� (9-S� d p hn5 ,
Ow ner Q n5 4o �-rn o f G� Y (�c U'L c'(-Q Y-
1212VO4

Facility. Number Date I :3 Time IN r io ' Out
Owner__,.,
Farm Name
0-.I-C
No. (''� i% U c�' y ✓�
C.O.C. General NPD
Design Current Design Current
Wei Wean to Feeder
eeder 3�U Farrow to Wean
Farrow to eeder Farrow to Finish
Gifts,, Boars .
Other
Crop.Types c�ye „__ , _...,, Pan Ito Window
_ l�sa-Z/, 0�A.
WarnQ LAA
—
1 5�
Soil TesPlate
Designed Freeboard / L /2 Observed Freeboard /-Z
Rain gauge L--Rain breaker ® Daily Rainfall Waste Transfers
Calibration of spray equipment G.P.M.
Sludgq,Survey ✓ Crop Yield120 Minute inspections'
1 in. Rain inspections Weather code � Weekly Freeboard
p Y
Pumping time
Wast�y Analysis % & Month
l
�� )/3
Comments C
.V

Date of Visit: Time:
Facilih• Number
Not O erational 9 Below Threshold
'Permitted S Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above. Threshold:
Farm name: — icpc /1" eld e 6" County: A0, Fi? a
Owner Name: _ 70A, W, A y—, s Phone No: ��� ' , li �� ' C "16 3
Mailing Address:
Facilit%• Contact: — 04n Title: Phone No:
Onsite Representative: %2Aa - Integrator:
Certified Operator: rn r Operator Certification Number:
Location of Farm:
made ❑ Poultry ❑ Cattle ❑ Horse Latitude a 9 . Longitude • �• Du
Design Current Design Current 'Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Po ulation
❑ Wean to Feeder 10 Laver I 1 ❑ Dairy
❑ Feeder to Finish ILI Non -Laver I I IFI Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder1 Other
Farrow
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area S rati Field Area
:.,Holding Ponds / Solid Traps • ❑ No Liquid Waste Management System
,t
Diseharges & St_ream Impacts
1. Is anv discharge observed from any part of the operation? ❑Yes ❑ No
Discharge originated at: ❑ Laeoon ❑ Sprav Field ❑ Other
a, if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed,what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): JAI
05103101 Continued

Facility Number:'jr7 — ( Date of Inspection $ -O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional] Yes ❑ No
Air Quality representative immediately.
UsFe dra} wingF s df faciliihkto a�€pag(Ee°, sa1s 1�nece.t{'�'e.
pt
,y `?', 1Itl"3: Field L�`
°
r'"In.-f'sr�pi&,E :� [„F
D WQ SfQeF ,7rl .sia rvc o/ {'
VISYt a/',r, R5 4 /'PSu/T Q14 6o1-1t,rw
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 8 '/3 O Y
12112103 Continued

Facility Number. 77 — Date of inspection
Required Records & Documents
2I.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22.
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
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
R] es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
©
No violations or deticiencles were noted during this visit. You will receive no further correspondence about this visit.
ddltlonal Comments` and/or Drawln,... r[ n t €k € +'" {:r I "; a , ;g, s" , r ; €fI ff s>>;, fr €{{', .4 ' z iFf , r ^'¢I ,1.i E« %4
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12112103

08/15/2004 20:37 FAX
p ,k�
R.CO.SHERIFF AEPT
001
y
a

08/15/2004 20:37 FAX R.CO.SHERII:F DEPT IM002
August 16, 2004
MARK BRANTLEY
DIVISION OF WATER QUALITY
Attention: MARK BRANTLEY
Dear MARK BRANTLEY,
SUBJECT:JOHN WILLIAMS FARM
The action that will be taken to eliminate the problem of being in the freeboard area of my
three lagoon is as follows. I will apply to the fields that I have in my Waste management plan in an
agronomic matter the excess waste water over the neat thirty days in order to reduce the freeboard
levels.
Sincerely,
JOHN S. WH.LIAMS JR.
549 VEST riwY_ 73
ELLERBE, N.C. 29339

(Type of Visit O Compliance Inspection O Operation Review • Lagoon Evaluation j
Reason for Visit O Routine O Complaint 0 Follow up O Emergency Notification Q Other © Denied Access
Facility Number '� �^ i flate of Visit: ® Time: Z
0 Not Operational 0 Below Threshold
Permitted 13 Certified © Conditionally Certified j3 Registered Date Last Operated or Above Thresshold:...__._....._.. _..
Farm Name: ....... _.� _._Rlok` lP�....1... 3 1k±!_............_.._............ _._ County: ».».... '» .f:! xsal�............_ .._._.__..._._..
OwnerName: .............. ..._........... _ ..._.._._......... .._._....._._.....__....... ' Phone No: ».»»..»»..».........»....»..».......».».» .... .._............
Mailing Address: ...........
_»._................_._....____ ......._..» ...».... ...... .._... __ .._._.....__._._._..._ .... _...._._........__.. ......_...._. »..
Facility Contact: _ . __._.. _._ .._....._..........._..___-_---Title:
Phone No: _..,_._.____.__._....__._........
Onsite Representative:.._...._..._..._.__........__.__.___.____..._._...._........»......... Integrator: .......... .................
............_ _......._._._...... „..
Certified Operator:. . _.._._....__ .. _ ____._._.___......._ . _..._...._... Operator Certification
Location of Farm:
❑ swine Q poultry ❑ cattle ❑ horse Latitude • 4 96 Longitude ' 4 «
Swine -
Ca Cif
Desiign � ��Cncri
- - ---'
El Wean to Feeder
❑ Layer
Feeder to Finish
t ❑Non -Layer
Farrow to Wean
'
16
Other:
❑ Farrow to Feeder
Farrow to Finish
TOt8I;Desij
a ;i
Gilts
❑ Boars
Discharses & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
,Desiga �- Current`
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........... ............... »».»................. ..............
Freeboard (inches):
12112103 Continued

Facility Number: =.'4— 1 Date of Inspection
Y' Are here any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, j] Yes ❑.No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
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 ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Field Cove ❑ Final Notes
A t � Ytp a4 �:Ia( v+n� .1 . ' W i u. I a w c.
a+ Atb8 0f. HC C.c4r-Avo t -ate.. 8rv-v "_�, 6� w s
C&- a wwwwa-[ vwtive . ��oc5r- #Z s saA- a+ " by a„ � ove.r{{&•.J
up -
3so cal PW,V . 5Qroly i r-t awl, IQ, tr•a-6 s ovex-be ftL . He era"`
-� vat ► -� z , ��.r ��ld �.�, �'(� t v`i ��''
ReviewerAnspector Name
Reviewer/Inspector Signature:
12/17M4
Date:
C_'entinusd

Division of Water uali}� � u � ', �,� � � �h «,
Q . kJ �^ 5r�+f. e��, t R 2'k ; , '�:� �, f w "t�',?li�� �i i s�3,I
{ 6ivis�on-of SoEI and Water Conservation " t� �k .:
4 �, 'T
OOtherAgency vr- 0. �'�, 1 -� .{ i �� ,,r`a . �� d p ! s� IFh ,t F P. r5 ,S,,yfUds"rz.$'
' v,�s � a n �-.,� � t a.' •'�n ,..� �, f ply .: 4 a ��_ ,, r� . ''� d i-:� � k� i'.�' ��; ��'���'
'
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
FFacility Number 77 1 Date of Visit: 8123/2fl04 Time: 11:fl0am
O Nat O erational O Below Threshold
N Permitted ® Certified © Conditionally Certified © Registered Date last Operated or Above 11reshold: .........................
Farm Name: RQCJkY.Rid9C.k'Arw...................................... ................................................ County: mchmom(I........................................ FRO .............
Owner Name: dohn.jS ..................................... .kYIMORM....,............................................... Phone No: 9.1.945Z 5.46t3...........................................................
MailingAddress: 549..NC.k]wy...7,..W..e5.t.............................................. I.......................... UJubg... N.C............................................................. U133.8 .............
FacilityContact: ..............................................................................Title: Phone No:...................................................
OnsiteRepresentative: ........................................................................................................... Integrator: N..C.Ruimis..1;.Oxm.109......................................
Certified Operator: jpjhany..S............................... WAWAINKAr .................................... Operator Certification Number: 1.7.659 .............................
Location of Farm:
Imiles Northwest of Ellerbe and go 1.5 miles South of NC 73 on SR 1310 (Bennett Rd.) +
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 • 45 25 Longitude 1 79'F 47 i 13
©esi t! Current Dtsin ;''Current
g g Caesign ;Current
Swine , ": ,Ca'actt Po ulation Poultry Capacity' Population;:. Cattle', pacify Population
❑ Wean to Feeder
® Feeder to Finish
5300
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other^
Total Design Capacity 5,300
Total SSLW 715,500
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 & T'reatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Stnicture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identitier:.................1.................................2................. ....3................ .
Freeboard(inches): ................................... ................................... .............. 38................... ...................................
12112103 C:onrinued

_............
Facility Number: 77—t Date of Inspection 8/23/2004
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
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
❑ Yes •
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ® Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Comments (refer to question #): Explain any, YES answers and/or any recommendations or any:oth_er'commentS:)
Use drawings of'facility to, better explain situations. (use additional pages as,necessary):, ® Field Copy ❑ FinalNotes
Farm was visited as part of high freeboard follow-up. During the inspection a swine carcass was observed at the end of one ofthe
confinement houses. It appeared to have been there for some time longer than 24 hours. In addition some of the foundation walls had
small leaks of waste coming from them. Inspectors contacted Mr. Williams and then discussed these issues with him at length, He
committed to cleaning up and properly disposing of all dead animals within the required 24 hour timeframe. He stated the carcass
observed had been stuck in the house and they had just removed it. He stated he had not been giving the farm the attention it needed but
had just hired a man full time to assist him. He will repair the leaks immediately.
-77 17 - ;
Reviewer/Inspector Name Larry -Baxley _ ' ,, • :Mark Brantely
Reviewer/Inspector Signature: Date:

Facility Number old
of Visit: 9 10 0 Time: l
Not Operational 0 Below Threshold Q
13 Permitted © Certified 0 Conditionally Certified 13 Registered
p n.
Farm Name: ........... LS.�I C-..41 � ..........l ickM.�......»»...._.....»----»._._
Owner Name:
Date Last Operated or Above Threshold: ..... . .... . ... . .......
County:
PhoneNo: .»......».._.»._.»».. __•W____ _ »..»»» ».».
MailingAddress:
FacilityContact: ..»....».»._....».».»...._._.__ ...............» ..»....»..»» Title: ... ........... ...._.............. __...... _._... _..... Phone No: _...... .» ........».......»..
OnsiteRepresentative; ....__....... ...»»...»_...»_._»._.._»._.».»».......»__...».. Integrator. ».»._ . _......._...».. _ _.............. » . »»» . »....__...
Certified Operator: , » ». »..»., .... _ ... _ -------- , ». , ,. _ Operator Certification Number:_-------_-_-.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' &4 Longitude • 4 44
Disc es & 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 & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 5
Identifier: »» » i ___ .._ ..._». ZG.._-
Freeboard (inches): L Z dVPAOP'
12/12/03 +� � w + i it
�' ` V� Continued
1

Facility,Number: �-�— ..,1 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 ❑ Yes ❑ No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Croptype
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Lasues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
;V4MWings or+fae�ity'w�detterertpsatn sttaatioas. (use�aawn0nal pagrs&aslue r�!)s ❑ Field Copy ❑ Final Notes
�p
a�.?77� 1., i'T. �, W ..°.�,� MUM ..r .:Se;ii.� i�' r'.�Jii� � 9 11 { a�!' a;
a� o�r+tirt ►'v�.'�- rmi
Reviewer/Inspector Name =11
Reviewer/Inspector Signaturer
Date: 9 / f o / o
VI / VI 2
WON —
Continued

4.
Facility Number Date of Visit: a o Time: % 15 t<
10 Not Operational 0 Below Thres uld
® Permitted ® Certified M Conditionalh• Certified © Registered Date Last Operated or Above Threshold:
Farm Name: County:. CQ,..XA'Ck
Owner Name: _ ___ s,jl'L.�,a, l�ri �,],i G.r�Li _ _ Phone No:`
Mailing Address: `� �.t_Q� C._ i c.r 19939
Facility Contact: __ J k4 , W 4 L i G wAS Title: Phone No:
Onsite Representative: me g
-� f rator• � •
Certified Operator: .] t3ir+h L.t i gj'M<_ Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 e ' 4 Longitude 0
Design Current
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish t7aLL.3 oa
❑ Farrow to Wean
Farrowto Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 3
Holding Ponds I Sblid Traps C
Design Current Design Current
Poultry Ca acity Population Cattle Ca acitV Po ulation
❑ Laver I I❑ Dairy
❑ Non -Laver I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
w �
tiSubsurface_ Drain
❑ No Liquid Waste
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laeoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of 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?
Waste Collection & Ireatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 1:1t
05103101
❑ Yes F'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes M'No
❑ Yes P-No
❑ Yes � No
Structure 6
Continued

.y r".
Facility Number: U— I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes kO No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [j.No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Analication
10. Are there any buffers that need maintenance/improvement? ❑ Yes Q[ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes � No
12. Crop hype Re.rr, ,J-,,— Pei) G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Q No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes [:]No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired 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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes 0 No
❑ Yes ®No
❑ Yes [9 No
❑ Yes [ No
❑ Yes ® No
❑ Yes [�g No
❑ Yes ❑ No
❑ Yes ED No
❑ Yes EgNo
❑ Yes f�o No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes 91 No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
v✓r v✓r vi a.vN[[[[N�N

Facility Number: ( Date of Inspection 3 t5
dor ISm
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ri 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 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 [K No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:, . �" r,, ;:_ < �� �I°_ hr :, n � � a ��� i�., . �,3.1 e:!_�i ... �h € .3;ij!
05103101

,Ji'V�. 0,,D}Vislop-ot'.Water.,Q llalijty _r �� a a`"t 7�'. r7. :y �c 4 r���a n .4Y,1 Y� �� c"r•'�"zfl�� ',3
D}vision of Soil and Water Conservation
O':Other,Agency.':n .
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Late of Visit: 03101i/2003 Time: !�
Facility Number 77 !
NNot O erational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: IZ4lrkY 1�1d.F�Cm .............................. County: f�Cbojgj J............... ..... ?A,!?.........
Owner Name: dohnS .4i'illiLaars Phone No: 9�Q-65�-463------------------------------
Mailing Address: S4QACAW.y..7.3..?.CaL........................................................................ Ulgrk..N.0 ............................................................ 7.8,33.8 ..............
Facility Contact: ,Iohn.W.iUiauts....................................Title: 0.wnC.................................... Phone No: ......................................
Onsite Representative: JDhA-1 lUlS[U5Integrator: N.G.FACASJEAr S.JJlt:.------------------•
Certified Operator: dahuffy..S................................W.itllAa=..................................... Operator Certification Number: 1.7,659 ............................
Location of Farm:
Imiles Northwest of Cllerbe and go 1.5 miles South of NC 73 on SR 1310 (Bennett Rd.) A
®Swine ❑Poultry []Cattle []Horse Latitude 35 • 05 25 Longitude 79 • 47 ' 13
Design —,Current
Swine CaUackv (Population ' Poultry.:
❑ Wean to Feeder
® Feeder to Finish
5300
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
resign ,Current Designs.
acit Population Cattle Ca acit
l� Dairy
Number of Lagoon3 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdin'g Ponds/ Solid"Traps : ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated now in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of 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?
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
Structure 6
Identifier:
Freeboard (inches): ............ 12............ ............ 1.2........... ._. ........... ..........................
05/03/01 Continued

Facility Number: 77-1
Date of Inspection (1310612003
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenance/improvement'?
8: Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aunlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ 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?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Pen -nit 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 tail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to,question #) Explain any YES answers and/or any recommendatrons or any oth6r,commcnts tg.
..
Use dra'wings"'of.facili"ty to better explain situations:'(use'`additional pages'as necessary): }❑ Feld Copy Final Notes
Field
— '
Site visit in reponse to Mr. Williams call to DWQ reporting high freeboard levels. Lagoons 1 & 2 are linked to 3. Lagoon 3 is set up to
hold storm storage for all three lagoons. Mr. Williams was informed that he could transfer waste using his equipment to his son's farm
(77-5). -Mr. Williams will update DWQ periodically to inform of freeboard levels. Field were too wet to irrigate at the time of inspection
POA coversheet was completed and returned to FRO.
r
Rcviewerllnspector Name Paul Sherman.=:. �.
RE Signature: Date: