780036_INSPECTIONS_20171231

NORTH CAROLINA �
Department of Environmental Qual
II

Ilr
- ivision of Wa#er Resources
Facility Number - ® O Division of Soil and Water Conservation
Q pater Agency
Type of Visit: Compliance Inspection 0 Operation Review Q'Structure Evaluation 0 Technical Assistance
Cmp
Reason for Visit: Routine Q Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �74 County:
Farm Name: ���„t.� � COwner Email:
Owner Name: �r��`zi� F�t(?~� Phone:
Mailing Address:
Physical Address:
!C a Pip Region: f
Facility Contact: VAI`wclr_ L-0 c4f f cr Title: Phone:
V ` � Onsite Representative: + f Integrator: I3 —s
Certified Operator: t c Certification Number: I F-3f tic
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop- Wet Pouttry Fapaci#y Pop. Cattle Capacity Pap.
Wean to Finish (Layer Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
5 O
I Da Heifer
Farrow to Wean
FjDesj�gnCurrent D Cow
Farrow to Feeder
Dr P,oul a aci i?o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other
Turke roults
Other
Dther
_L__�_
MW M �=M
Discharges and Stream tmoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ejj-W
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[lA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
Eg-N7T­- ❑ 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
EfNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
-En-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

f acili Number: - Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-Nt,—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [aBA ❑ 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
❑ 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
fDK5 ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�❑ 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
E3-N`6­ ❑ NA
0 NE
maintenance or improvement?
l
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� ❑ 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 W 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): C9 J� I P _
13. Soil Type(s): C O -- w z- kc4-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�J. ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Zj-3d6—_ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes V]'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3_N6--❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I�"o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D No ❑ NA
❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, check
❑ Yes
'Co ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes [Z
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I__I ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facie Number: j -TIT jDate of Inspection:
14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-N r ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E7_7Vo_- ❑ 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 siructurc(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure. a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 allo ❑ NA ❑ NE
❑ Yes E2Imo [] NA ❑ NE
[]Yes [ lTo ❑ NA ❑ NE
❑ Yes [J'No ❑ NA ❑ NE
❑ Yes [�J�o NA ❑ NE
❑Yes u'Vu [3 NA ❑NE
❑ Yes
[3 11O
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
Comments (refer to question ft 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:-Ito"�J �-3�3q
Date: �-
214,415

Division of Water Resuur"ces
CaCNImber ®- 3/ U' Division of Soil and Water Conservation
� Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; D 7 Departure Timer _'pp County: zIn—Region:
Farm Name: ��(�� z"k"d��� Owner Email:
/?lI-411-1e
Owner Name: / .D G�r Phone:
r
Mailing Address:
Physical Address:
Facility Contact: %i%ri%G �y�j�,��r Title: �LIJ/T`G� Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desiga Current Design =Current
Design Current
Swine Capacity Pop. Wet Poultry Capacrty ';.Pop:' `'` Gattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
1DrvCow
Farrow to Feeder D . P.ou1t ; Ca aci Po
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -La ers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Uther Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 QjNo ❑NA ❑NE
❑ Yes
❑ No
_❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
Rj No
❑ NA
❑ NE
[:]Yes
�dNo
❑ NA
❑ NE
Page I of 3
21412015 Continued

Facili [Number: 2 1 Date of Inspection: 1%
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
G Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
T
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 Q 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 RNo
❑ NA
❑ NE
8. Do any dfthe 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 O No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Ea�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Tvne(s):�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K] 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 [:]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
[K No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[KNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
� No
❑ NA
[] NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes 0 No
❑ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R[ No
❑ 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 Ea No
x
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fo No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and dale of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes D�[No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IQ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with -an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑Yes MNo ❑NA ❑NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes JgNo ❑ NA ❑ NE
❑ Yes Ej No
❑ Yes [& No
[:]Yes MNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer o queshani#) Eirplain any YFS answerskand/or eny addrtional recommendations orb any�other comments.
Use dlrawings'of faci�lrty to better,ex tarn situations: use ad peg necessary).
,...
p ( ditional es as necessa
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date: _/,2 —�7
21412015

i ype of v Esir: k:j­uompuance inspecnon v uperatron xeview V atrucrure bvatuanon V 1 ecnntcat Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: - c County: Region:l91�)
Farm Name: Sg4Ia ej �- OCII e-.C.^ �`r"' Owner Email:
Owner Name: ti Phone:
Mailing Address:
Physical Address:
Facility Contact: ti G r1G"r''1 Title: Phone:
Onsite Representative: � i 1 Integrator: 44g ,
Certified Operator: Certification Number: 3l
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
_
Design Current `
`
Design
Current
Design Current
Swore
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Laver
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
-
Design
Current
Dry Cow
Farrow to Feeder
D . P■oul
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers.
Beef Feeder
Boars
Pullets
Beef Brood Cow
.. i
Nz0l
Turke s
O_the�}
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 E .Alo [DNA ❑ NE
❑ Yes ❑ No E]WA ❑ NE
[-]Yes ❑ No [3IA ❑ NE
❑ Yes [:]No
❑ Yes 2190
❑ Yes [�No
[g'NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Q�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑-Ko ❑ NA ❑ NE
[:]No a< ❑NE
Structure 6
❑ Yes [2"go ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
I13 "'o
[] 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
C3 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3"N'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CZ14o
❑ NA
D NE
maintenance or im rovement?
P
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): &-✓^ 1/( �_ S �jc) ..16 _+_ tr/
13. Soil Type(s): ����./�����G _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3'1�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;yfTo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�JTfo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [allo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
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
[2*&o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes
[214o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

f -
Facility Number: - Date of Inspection: G
4k]
�4. 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
0 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
[t No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[D4o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
L;�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
ZNo
❑ 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
PfNo
❑ 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
<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E!rNo
❑ NA
❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gE No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question t#). Explam any, YES;answerstand/or='any additional recommendations or: any other commenfs: t,� 4e1_,-_-
'�'�" ..,*�. : �.: = � .�• . •. ...� . -�-�. �
Use drawings of facility.toybetter ezplam situatiins(use.:additional pagesass necessary).`
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
` "I �33-333�
hone:
re: Date'
0a 1
21412015

Type of Visit: tjCom ante Inspection V Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:,- Region':
Farm Name: so, + ��'i jG� Owner Email:il�
Owner Name: l i Phone:
Mailing Address:
Physical Address:
Facility Contact: Y44A4 LAIC jgw Title: Phone:
Onsite Representative: Integrator: R,6
Certified Operator: Certification Number: �3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
C►apacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Desigu Current
Cattle Capacity Pop.
airy Cow
Wean to Feeder
I JNon-La er
_ - _�
D , P,oul
Layers
I
' " "
Design
Ca aci
Current
P,o
airy Calf
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Feeder to Finish
5 2D
�
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
1.1 Other
Turkeys
Turkey Poults
Other
Other
Discharees and Stream Imrfacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑.1' o� ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No fNA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No [ f <A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No [31<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [f'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yeso ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDateof Inspection:
Leal
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3}iTo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[RNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Jc.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ -No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E 1"o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]'l�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3-No­
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�fi oo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q oo ❑ 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 oofi
,,�yWind Drift ❑ Application Outside of Approved Area
e
12. Crop TYpe(s)� - l� G� iz-No PA ' (t/
13. Soil TYpe(s): [n ►2' 1` otvj 16Ao Po r jjt j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [E]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes [!J�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes C]'&o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[✓TNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[frNo
❑ 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 I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,/
❑ No
❑ NA
ONE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection: dy,
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E]-*u
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
E 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?
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 file 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?
C 1 q
SIwR� sU 1111 ILl
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[-]Yes [ o ❑ NA ❑ NE
❑ Yes ['No ❑ NA ❑ NE
❑ Yes [5No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [TNo
❑ Yes [J-No
❑ Yes ["No
moos or any ou
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: L1.�3-333`�
Date: �14ti.
214120I4

Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Type of Visit: fiance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Tr Reason for Visit: URoutine O Complaint 0 Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: lc County: Region:
Farm Name: - `ayUtk+.iLp(� /� .l'�+�1 Owner Email:
Owner Name: k L Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:IOQ
Certification Number: [ U ( 6
FLA
Certification Number:
Longitude:
Design@arrant ECffipq:Ni&!tyv
gu �e t Design Cnrrent
Swine Capacity Pop. Wet PoultryPop Cattle Capacity Pop
La er DairyCow
Non -La er DairyCalf
_ wav
Dai Heifer
rent D Cow
D , P,oul _. Non -Dairy
Layers Beef Stocker
Non -Layers �r Beef Feeder
Pullets Beef Brood Caw
Turkeys
Qther Turke Poults
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑Yes ❑-Ko— ❑ NA ❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made? ❑Yes ❑ No [D.AIA ❑ 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 [I NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑Yes []3N0 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes [' <o ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 2/4/1011 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z].lqb ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes [�' ❑ 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
[2.Ncr- ❑ 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
[D-#b ❑ 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
r No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ja -No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C3,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 DriiJft ❑ Application Outside of Approved Area
12. Crop Type(s): L. Q NA Y �. ]S(so
13. Soil Type(s): b POC4. ff
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2*1Go ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [:]Yes [J No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [Ll<o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ 1<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ©,<o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [JNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 26No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El-N-b— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-NV— ❑ 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 ICJ o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes t No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes bNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes R To ❑ NA ❑ NE
❑ Yes [3 o ❑ NA ❑ NE
❑ Yes Eg'14o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ hlo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [50No ❑ 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 an additional recommendations or an .other comments "`
( 9 )• P Y Y Y -
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phoh�:V'�`��s�SSs 1
Date: -a]%t
2/4/2t711

type of visit: qA-c:ompuance inspection V uperation xevtew u structure r:vatuation V lecnn►cat Assistance
Reason for Visit: ("outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: KKjj Sj (�'V- F Arrival Time: Departure Time: d County: 16.E
Farm Name• r f o ". -JQ Owner Email:
Owner Name: u _'L"" Phone:
Mailing Address:
Physical Address:
Facility Contact: flA L_ot �'� — Title: oci .� /U _ Phone:
Onsite Representative: �, c 1-\ c1ch(,—I- Integrator:
Certified Operator:
Back-up Operator: ��� ��✓"
Location of Farm:
Certification Number;
Certification Number:
Latitude: Longitude:
Region:
Design
Current`
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry Capa ty
P00.
Cattle Capacity Pop.
6Gc)
La er
Non -La er
+ it
y .
Da Cow
DairyCalf
Dai Heifer
Wean to Finish
Wean to Feeder
Feeder to Finish
1]
yam"
Design
Current
D Cow
Farrow to Wean
D . R,oul '. Ca "itci
La ers
Po
-Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
NJ
Boars
Pullets
Beef Brood Co —
Turkeys
Other
Turkey Poults
Other
-
NJ Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes [—]No E]-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 03'<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [v] o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes fo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑. q-o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 09 n'o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
[
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑e •
❑ 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
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
B o
❑ 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): f�4c-� _- — s ( oS
13. Soil Type(s): CiV o ► , 1 e.& r ' I c., i 6o ,
14. Do the receiving crops differfromthose designated in the CAWMP?
❑ Yes
[ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
®�to
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EB"Ro
❑ 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
021�_o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
�la
❑ 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 6<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes h€o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes io ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IE+'aciliNumber: - 7971 &1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
©,V-o ❑ NA ❑ NE
a-K° ❑NA ❑NE
❑ Yes
8-1�o
❑ NA
❑ NE
❑ Yes
D I' o
❑ NA
❑ NE
❑ Yes
[BNo
❑ NA
❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ODNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. E] Yes � N
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [R'Ro
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No
1�4tqe'a'_ eci (ze'cot;
Reviewer/inspector Name: 1
Reviewer/Inspector Signature: 4
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone:L7fo �3
Date: " V
21412011

tf,
EaaE}iy No_ � � _ Time in Ct Tone Owl _ _ i3at� 840
=arm Name f. U4 �� _ Integrator yj
Oc��e; lr Site Re
- _ P
Operatof L—
Back -tip No-' -
COC Girder Genera or - -NPDES
Wean — Few
D
Current
Farrow — Feed
Des`
Current
Wean - Fulsh
S
(9 cO 0
Farmw — Finish
Feed — Rnish
Gilts !Boars
Farrow .:. Vfean
Others
FREEBOARD_ Deli
Sludge Survey. v
Observed
Calibration/GPM
Crop Yield �'-' Waste Transfers
Rain Gauge Rain Breaker
Soil Test PLAT_ Wettable -Acres V
Weekly Freeboald D ly-Rainfall 9-in lnspeciions -
SpraylFrebard Drop
Weather Cosies , i,,— 120 min inspections
Waste Analysis:
Date Nitrogen (N)
Date Nibmgeri (N)
1,761
V
■
MMMOMW

Type of Visit: WCo/mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:`"�-'-'iJ Arrival Time: Departure Time: p County: �II
i
Farm Name: &` rA (N\ V�r_k 1 �%n cK ?_VS R �4g (krrl Owner Email:
Owner Name: �WAM'L)Qt 1 VCx ikkMV' / main- �,.ne &Phone:
Mailing Address:
Physical Address:
Region: M`
Facility Contact: MM jR zC 2 _ J„,,C- 1L\ E m A Title: _ 0 w rM Phone:
Onsite Representative: t`t�taulLiS_kp,{Z Integrator: _ mVRD�,) _ QtZG'jx]
Certified Operator: {'f�Ay(�=C� �.C�Cjr.�F_� Certification Number:f j (�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
-
Designdw�Current
tesigny
CuapacioultryCacitPop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish '35 Xp
Farrow to Wean
Farrow to Feeder
3000
Design Current
Dr. $o.ul_ Ca aci P,o .
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Y
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
62vo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[DNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
aNA
❑ 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
[ A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[::]Yes
[]vivo
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
Ca**N- A
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

r ` 5 -7 it
Facility Number: - L9 Date of Ins action:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[fNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Co"NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: # 1
Spillway?:
Designed Freeboard (in): yq
Observed Freeboard (in): 3a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[1 rNo
❑ 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
[21"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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
52No
[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
E? No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:D Vo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window r ❑ Evidence of WWind Drift [] Application Outside of Approved Area
12. Crop TYpe(s)- 123 T . R tR. , O R 11'liati t 1 G(kA2 — i _ G• t1
13. Soil Type(s): _UP, K u X\ A , Pa _ ta\t A 3 " NA % b O P-0 , 05 La ad. _
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes QNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ , &o ❑ NA ❑ NE
❑ Yes 0/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 02'No [DNA ❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design [:]Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q44o
❑ 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 ff 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
[TNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 's - Date of Inspection: '1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [53"'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes Cj�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA BINE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [D'No
❑ Yes [�rNo
❑ Yes [R'No
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft 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).
Gzx,p vPaz n
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910-308 -/ $6- l
Date: S 11 d T
21412011

I ype of visit: V compfiance inspection U operation Review U structure Evaluation U Iecnntcat Assistance
Reason for Visit: 04o`utine 0_Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: z
Arrival Time: .Q GYJ Departure Time: ;Cej County:l�i, )
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: %iTitle: 404e.e�
Onsite Representative: Integrator:
Certified Operator:
Phone:
Region:
14— 4
Certification Number: Ze.3
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
n -'' Design Current'
Design
Current '
Design Current
Swine Capacity Pop.
Wet Poultry Capacfty
Pop.
Cattle Capacity Pop.
-:
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean`
Design 'Current
D Cow
Farrow to Feeder
D . P,oultr Ca `aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- -
Turkeys
Other
Turke Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes o ❑ NA ❑ NF
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ERI<A ❑ 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)? 14
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 [ �OEJ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No Ca<A ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EDO<
❑ NA
NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in): 45
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ET<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes -
io
❑ 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 eat, 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
Q.#6"'
❑ 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
[]L 1
❑ 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
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): jc"")
13. Soil Type(s): A-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Do
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q.d'1"o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Lddq NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ion^ ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 [gNo ❑ 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 Eg o ❑ NA❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes ❑ No Q-11AB❑ NE
Page 2 of 3 21412011 Continued

V
Facility Ntfmber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Er5o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3-Ko ❑ 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 Orin% ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3'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 ®'1Vo ❑ 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 ❑ 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
IDS 1"" ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]-?To-- ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Ej-I�o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
QM5-__❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1a 333
Date:
4l20 I

i/;ls s- 19�1-2010
Type of Visit OCompliance
Inspection
O Operation Review 0 Structure Evaluation
O Technical Assistance
Reason for Visit
outine Q Complaint
O Fallow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: 9.*20A;: Departure Time: //:OS ,rr County:
Farm Name: Sa►-t%Ae I LpGkl eei— Farm Owner Email:
Owner Name: _54-44lsl Lockie4,.. _ Phone: _
Mailing Address:
beSon/
Region:
��
g
Physical Address:
Facility Contact: XQ a v;c e _ Lo c.kle4 Title: Maua _ Phone No:
Onsite Representative: Integrator: i-bL Jlnl
Certified Operator: /vaaPl C 4c- ���-K+GAY Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = u Longitude: = ° = { 0
4
Design Current
Design Current
Design Current
5s.ine Capacity Population
`Vet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
® Feeder to Finish 35Z0
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
R'C
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
O No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
El No
,,_,/
LNS�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El���,, No
L'�[vA
❑ 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
El No
,�,,�
LJ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
2 No
❑ NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
,
L+� No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

. Facility Number: '] -- {p Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [TNo ElNA ElNE
a. If yes, is waste level into the structural freeboard? ElYes L!7 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r/
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E7 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [-IYesE-'TNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require El Yes
,-,�
37 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ffNo ❑ NA ❑ NE
maintenance/improvement?
It- Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
O 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 El Evidence of Wind Drift ❑/ Application Outside of Area
Window
l2. Crop type(s) &V'A4K 4, i ta►'�;e-
13. Soiltype(s) Gokjs so► -a, POCAatla- , Wlc�%--lbovo
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,E.'�,
[B Nc
❑ 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
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;N*o
❑ NA
❑ NE
(6 eE&(N[er to question #): E�platnsany YES answers and/or any recommeadation_s or any other comments.
Use drawings of facility to better explam�setuations. {use additional pages as necessary}:
m_.°.
1
t/ U l.'_ C_G- IJ YG I ►1 L 5 4, V C n! L 050L .a Sta r c/ y l
Reviewer/Inspector Name }�i� e.�e 1 Phone: 910,g33.3.300
ReviewerllnspectorSignature: Date: �4-_30-20/0
Page 2 of 3 `� 12128104 Continued

Facility Number:-7 g —3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
❑ Yes
E3 No
❑ NA
❑ NE
❑ Yes
LINO
❑ NA
❑ NE
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?
El Yes
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,E5"NNo
LB
[I NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N.
[j� Noo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ 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
,�/
!� 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
ClYes
M 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?
El Yes
,�
t_'J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ET/No
❑ NA
❑ NE
e --
Additional Gommerits�aid/or Drawings
AL
12128104

a► A4< 5 -/�� -r)Q
IN
(vision of Water Quality
iFacility Di
Number i 3(0 0 vision of Soil and Water Conservation
0 Other Agency
Type of Visit orrompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -a Arrival Time: %//Q:OD/,L�r Departure Time: %% CdOiGnr County: A Region: ��t9
Farm Name: `SJ!►7fil�� L/)C�C��x/" > Owner Email:
Owner Name: Sf17! 1 �r I Phone:
Mailing Address:
Physical Address:
Facility Contact: u �Ir U� Title: CLA-eel?, Phone No:
Onsite Representative: C % ��G�L�c !— 110.733• 261Y- Integrator:
Certified Operator: /VirrccricP �Al'i2�` Operator Certification Number: `a ��n
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = i = Longitude: = e = i = N
Design Current
Swtne C pacity Po ulation
p g
Dest n Current
Wet Poultry' 3Ca aci Po ulatfon
� p
Desi ii Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
., ❑Feeder to Finish
- F ,;� � -
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
.
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
Beef Brood Co
OtherI.�, F_�
❑ Turkeys
❑Turke Poults
b
❑ Other T
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
2NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[9 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
B<A
❑ NE
1 Is there evidence of a past discharge from any part of the operation?
❑ Yes
e No
EN' l NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
2'A
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued
P

Facility Number: —
Date of InspectionU
Waste Collection & Treatment
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
93-iqA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
,' !!
Spillway?: NCj
Designed Freeboard (in):
Observed Freeboard (in):.>
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®-5o
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
9YNo
❑ 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
93 o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes 2"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 Mo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes[flo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 00T 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
ErNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L34o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E30'N' o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2//o
❑ NA
[3 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�'h10
❑ NA
❑ NE
ReviewerAnspector Name T S Phone: 7—
Reviewer/inspector Signature: Date:
Pa¢v 2 of 3 12/28/0 Continued

Facility Number: —Q Date of Inspectio /'U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
/
E,No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E2<o ❑ NA
❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�
[], o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V
Rain Inspections ❑l Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2< ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No URA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Qlo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0-Ko'
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9-,go
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LP�A
❑ NE
Other Issues /
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [I�,
Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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
[INo
❑ 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
E?Iqo
❑ 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
ErNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
21�o
❑ NA
❑ NE
w a
Additional Gamments and/or Drawings"'
Page 3 of 3 12128104

f
® Division of Water Quality
Facility Number 3t/p 0 Division of Soil and _Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: 07-/Z-Q$ Arrival Time: Departure Time: County: R04ey0^1
Farm Name: Saw.ut l pore-.,% Owner Email:
Owner Name: SaIKu d La c. Klea;. _ Phone:
Mailing Address:
Region: IEX-0
Physical Address:
Facility Contact: _ Sit uG/ 40c4t1fe-be _ Title: ___00✓Nu4l Phone No:
Onsite Representative: �G�xc[G! Lacr�' [may _ Integrator: �K►iDh.. h7 �✓/✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = t = 1i Longitude: = ° = 1 = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity. Population Cattle
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish1752-0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[;2 No
❑ NA
❑ NE
12128104 Continued

d .. ..
I Facilitv Number: '7 g — 3 to Date of Inspection 42- /2 -0L3
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (59 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): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (2 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 [�VNo ❑ 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 [VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[7 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
CgNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[RNo
❑ 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 Drift ❑ Application Outside of Area
12. Crop type(s) 4� � �rry c�1�_ Slira�6Mii� �0.5, J
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
[21 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[H No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
QXNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[,TNo
❑ 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 j G K R e v 1 s Phone: 9/0, �Z3.3. 3360
Reviewer/Inspector Signature: ae..c.Li� Date: Z `/Z 4 ZaOg
12128104 Continued

4. . .
Facility Number: 7 — 3(� Date of Inspection 02-IZ-0
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�l No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� 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 [M 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
IB No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O'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
[;kNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENNo
❑ 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
[4'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
�2 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
[NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
F4VNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

,'i/
�Division of Water Quality =
Facility Number 7 $ 3(p O Division of Soil and Water Conservation
,.]- 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine Q Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5 '>R;7 Q Arrival Time: Departure Time: County:
Farm Name: 5amij4d flock lea r E4vwL Owner Email:
Owner Name: �a+�. i L i* r.Kl` A, Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: li�11 tv��C�- l�pC r`��F v
Certified Operator:
Ao la cso,y
Region: lz:Ao
Phone No:
Integrator• 11(uV Q ro .,_1 Ai
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = 6 =Cd Longitude: = ° = [ = u
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 L35Z0 2300
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Pouets
❑ 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?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
b. Did the discharge reach craters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes q9 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
[--]Yes
[WNo
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ®No ❑ NA ❑ NE
12128104 Continued

Facility Number:
.5-O'W-0V�-
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes On No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 30 _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J�fNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes]
No
❑ NA
❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ 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
[�PNo
❑ 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 �gNo ❑ 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 Drift ❑ Application Outside of Area
\
12. Crop type(s) B e VNl L4 CI (Pas kil { _ r F}Q,, �1+4 �i'rc.i N 60 v u.stc_ J
13. Soil types) G otCLT6o iro P� c�,l(a. ; dl/Gitr� b o ro 1�.b Kit (teams
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EX -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Q 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):
C9 b 0
(; o o d
ReviewerlInspector Name �1 c, v [ Phone: 4110, 5�33 , 3330
Reviewer/Inspector Signature: Date: S- OS - ZO o }
12128104 Continued

Facility Number: 713 —3 Date of Inspection S-oS-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E0 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 [4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[PNo
❑ 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
[;a No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[FNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[?No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P 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
rWNo
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Paige 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 02-L2 -0(c Arrival Time: O3: OO ,LDeparture Time: County: Ro6e_son1
Farm Name: _ SuMU9=1 LLB k1r.0.r Owner Email:
Owner Name: 5,% m Lkt. l L DC K i t-A Phone:
Mailing Address:
Physical Address:
Region: Fie•O
Facility Contact: Sap, Le G k 1 e.c v Title: O w t,2 gAe— _ Phone No:
Onsite Representative: Integrator: ,� ., 66,o n/
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o = 4 ❑ Longitude: ❑ o ❑ i
Design Current Design Current
Swine Capacity .Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 1357-0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made'?
Design. Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy lleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Conj
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 9No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
El Yes
LANo
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
[P No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
[](No
❑ NA
❑ NE
12128104 Continued

Facility Number: 7 $ — 3 (o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Flo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f t
r/
Observed Freeboard (in): Z S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR No
❑ NA
❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�ZNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [� No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes QrNo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 CAWNT?
❑ Yes
IgNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
CZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ NA
❑ NE
Comments (referr#o qu&doa-#} Ez RM any YES answers and/or any recommendations or any, other comments.
Use drawuags ayiia ty�to betterr�eztilsm situations. {use a�ona_ipages as necessary):
Reviewer/inspector Name F_R c_k
Reviewer/inspector Signature:
Phone: (C?/O) S(a !Sell
Date: ZZ 24o(0
12128104 Continued

_- -r .W.
Facility Number: -7g -3(o Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes EgNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [X 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
[X No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[X`No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ 3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�; No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[WNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
qd'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[$'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l .
Did the faMi ity fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency? '
❑ Yes
N No
❑ NA
❑ NE
Additional Coitiiments andlor,Drawtn s k -
� �
S ` -�, � r
12128104

of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other [3 Denied Access
Facility Number 9 Date of Visit- p '�-O Time:
0 Not Operational 0 Below Threshold
81iirmitt:ed G<ertified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _.
Farm Name: SaOn v LecIr/ � Fury., County: OGo d!3 �iPy
Owner Name: -?fi r r� ..- Loc c%rEic ___.......... 'Phone No: q1V - g L/Y " .S/
Mailing Address: I q /2 Mars l� /2e� r.� . -- ea,_>�_ Me- �g 36 y
Facility Contact: . lea &'r 4 e kler. - Title: I Phone No: !O - '-'y- SG o ig
Onsite Representative: /r1.��.�- Loci/rar - ----------- - -- --- • Integrator: _-Canee& 3�..�, ^L
Certified Operator: _ ck g , -_. - ,-o� , Operator Certification Number. -- JC11fo-------------
Location of Farm:
U] aGrine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �' �" Longitude •
Dew Carlseat T, _Desgn Cntrpni _ i?esegn; " Cuniet
Swine C,anac�rty. P0661;ifion.3;.P60bry, _.:-Caaacity :Poanlafiiar ,.Cattle Catty =Aovulation
o Feeder
to Finish
to Wean
to Feeder
rF
to Finish
Nnwlber �Ia�gooas -
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 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?
❑ Yes G-Ko
❑ Yes ❑ <
❑ Yes 0-ro
❑ Yes 0-No
❑ Yes Blqo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑-Piro
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less thaw adequate? ❑ Spillway ❑ Yes Q}No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): J-Q ~
12112103 Conibuted

Facility Number: — j &
Date of Inspection to-yo 0
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 structuues require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehtnprovement?
I I - Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type .Sih a /1s�...1 . [3ir," t/
❑ Yes M-No
❑ Yes E1,90-
❑ Yes MFTTO-
❑ Yes
❑ Yes BVi5'
❑ Yes [qo
❑Yes ❑Ko-'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Q-W
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 93N0
16. Is there a lack of adequate waste application equipment? ❑ Yes �o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 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 QNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑Wo
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 94o
Air Quality representative immediately_
:Comm (refEr mqa#) �E9tYES saswas anwr aay� _ - °r °° - --
Fist drawW beater Karmensitaa�ams {tee P ]') 5 [wield C ❑ Final Notes t -
qgg
Reviewer/inspecwr Name r
Reviewerllnspector Signature: Date: /47"-767.0 i

acility Number: 7 —3 & Date of inspection !O `�V
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Piro
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel, c}di'sts, drpiSletc.)
❑ Yes
❑-No—
23. Does record Steeping need improvement? If yes, check the appropriate box below_
❑ Yes
RN-0
❑Wa9UHhppjie&tkM ❑� ❑ ❑�� "
$ 7 24 L,-2,F y -3..2 .2-3,3
Yes
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑
EINB
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ENO
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
ONO
27. Did ReviewerlInspector fail to discuss review/Inspection with on -site representative?
[I Yes
RNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
a-Ko-
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
allo
NPDES Permitted Facilities
30. Is the facility covered under a NPDFS Permit? (If no, skip questions 31-35) P-Tees ❑ No
31. If selected, did the facility fail to instal] and maintain rainbreakers on irrigation equipment? Rfes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes QM
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 0'No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes EI�Wo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ fte ENtaildeft ❑
12112103

ITYpe of Visit e Compliance Inspection Q Operation Review O Lagoon Evaluation I
Reason for Visit 9 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: Time: 1 ySio
0 Not Operational O Below Threshold
E3Termitted Q Cerdfied [3 Conditionally Certified 0 Registered. Date Last Operated or Above Threshold: ... _. - .. .
Farm Name: S !I eee ....... County:.. .... ......-.... - ............. _ . f.ea .—
Owner Name: S L Phone No:
'Kailing Address: ! 91
Facility Contact : ..................................... —............ Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:—.--__.___-._
O Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude 0 ` "
Discbaraes & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ Na—
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 gaUrnin?
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 i
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B-No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ..._.......�................. ................
Freeboard (inches):
12112103 Continued

Facility Number: 2 ff — 3 & I Date of Inspectionf -D
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 Application
10. Are there any buffers that need maintenance/improvement?
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Gomme refei to;questiorj #I) ;Explain'arty"YES;answers d/ar'a y iecommenifations or an otherrco„ts�' :
'Use dra ngs of facrhty,to better explain sttrrattons (use addtponal,pages as necessary} ❑Field Cony ❑ Final Notes
7
Reviewer/inspector Name
Reviewer/Inspector Signature: ' l? Date: 9'9 -OEZ
O5103101 Continued

Type of Visit ® Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit 40 Routine 0 Complaint t) Follow up () Emergency Notification 0 Other ❑ Denied Access
"umber
Date of Visit: Time:
Facility �
Not O eratianal Below Threshold
Permitted 11 Certified M Conditionally Certified 0 Registered Date Last Operated or/ Above Threshold:
Farm lame: _ gym I-, el LoGl.—� ter Cor", Count-: p_�eSs-R
Owner Name: �„� eA IA Ct_ Lr,e.L � Gr Phone No: _ l 0 18-k-� ;D& I
Mailing Address: 31 a m o de G1 ad, C . _ ,`&
Facility Contact: L� W-yur- _ Tide:
Onsite Representative: Mc,tA r. Ce r o CL4__1 t-&r
Certified Operator: ►M e LkPjCD — "d_J e,&f_
Location of Farm:
Phone No:
Integrator: C.0 rt) II S
Operator Certification Number: 1 131 L
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current
Swine C'anacity Pnnulatiinn
❑ Wean to Feeder
BE Feeder to Finish
❑ Farrow TO Aeon
[] Farrow to Feeder
[] Farrox' to Finish
❑ Gilt,
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver 1 1 JE31 Dairy
❑ Non -Laver I I JE01 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ S rav Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Managoement Svstem
Discharges & Stream IMPRE S
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Svrav Field ❑ Other
a. If discharge is obsen ed, 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 eat/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 1 Smucture 2 Structure 3 Structure 4 Structure 5
Identifier
Freeboard (inches):
0510310.1
❑ Yes fo No
❑ Yes ❑ No
❑ Yes ❑ No
ElYes
❑ No
❑ Yes]
No
❑ Yes
®No
❑ Yes
1� No
Structure 5
Continued

Al
Facility Number: -- Date of Inspection h!!1 ?I
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (� No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [0 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 (i No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes B No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [Q No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes W No
11. 1s there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes M No
12. Crop type R P� rM (i A K J-' 1 c.n (ftz�42'1..:...h S
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
N No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
QNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
iP No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[&No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
5j No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
lain any YES answess and/or an3 rommendattons`or an other comments.
Coiriment(tefer toiquskt eon Exp ec
�,rawm.,gs ' of [acilrty4to-be❑ ❑ Fina i,.
sead Utter explairi sstuatitilas. (nse:addrhoaal;pages as necessary) Field Cony I Notes
Reviewer/Inspector Name A, e'
Reviewer/inspector Signature: Date:
05103101 Continued

Facility Number: �g — ��, Date of Inspection i O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes rM Lill",No
❑ Yes JQ No
❑ Yes 99,,IVo
❑ Yes Z No
❑ Yes JqNo
❑ Yes ❑ No

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine O Com laint O Follow-u of [M ins ection 0 Follow-u of DSWC review O Other
Date of Inspection
� FacilitF� Number � 3
j� Time of Inspection ' 6fl 24 hr. (hh:mm)
�1 Registered 13 Certified -- 3y Applied for Permit © Permitted 1 7-55erational Date Last Operated:
I Farm Natne:._QrW� U� L OG ea.. 1`Q rnti County: ii�%.1�r............................................
y j ...
Owner Name:...,-S 0," .0 _ I L o Gkl e a. r............. Phone No. �ram...............................
............................................. .J.................... . . ..................
FacilityContact l t' Title: „ GcJ ►1e.1-. Phone Na: Juke.
..............................nn...................................... Q.................... ,rye j ..................
Mailing Address: .....1.9.� 0 ..C' L .. 5 ...I.."...`..�'�X. a^_ ni.�?- ............................. .Z?3........
..... 6�
Onsite Representative:... Q t.t �t C L. ..L.r Integrator ..._... 4].`r.0_.l.l...'s........................................
Certified Operator......%l rr1�.rt C' L- �... Operator Certification Number
Location of Farm:
Latitude ' ' " Longitude • 44 '
.� Design Current
;; I?esin Current Design ;, Gurreut
Swme' 'Capacity Papiilat2on
- Pod iry Capacity Population Cattle apscrty i'apulahan
❑ Wean to Feeder
❑Layer ; ❑ Dairy
Feeder to Finish SZD
­❑ Non -Layer ❑ Non -Dairy.
❑ Farrow to Wean
Farrow to Feeder
El Farrow
❑ s..:
_-
❑ Farrow to Finish
Total Destgu Capacity, 3 52D
❑ Gilts
❑ Boars
.x �° x ' ssLwY
.... .�,._,....._._
,Total:
k•
_..k ... ,w .�.-'.w..✓r«, -•: ms`..ktv,.F.'crpq:r +Fe•:
+va'...,..
Number of Lagoons / Holding Ponds
A ❑ Subsurface Drains Present Lagoon Area ❑Spray Feld Area
-� .. ...
❑ No Liquid Waste Management System
General
1_ Are there any buffers that need maintenance/improvement?
2. 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 Surface Water'? (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)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the.State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes jNo
o
❑ Yes
Yeso
❑ Yes No
❑ Yes No
Continued on back

Facility Number: 'F — (�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (I,agoons.liolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes)<No
❑ Yes [ No
Structure 5 Structure 0
Identifier:
Freeboard (ft):............ ...........................
10. Is seepage observed from any of the structures? Cl Yes Vo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes #No
12. Do any of the structures need maintenance/improvement? ❑ Yes ANO
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste.Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff enteriny�waters of the State, notify DWQ)
15. Crop type ....... r.. l•..c.........................................................................................................
16. Do the receiving crops differ with thbse designated in the Animal Waste Management Plan (AWMP)?
IT Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No violations�or. deficiencies werenotedduring this:visit.- You.will receiveni o' A rther-:
correspondence ab:ou t this: visi t:.
❑ Yes *0
❑ Yes )�No
❑ Ye.o
❑ Yes YNo
❑ Yes )�No
❑ Yes IRNo
❑ Yes <No
El Yes / ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Commeuts�(refec'tn question #) t Explain anyYES answers and/or an 1econeht3aUvns or any other cantmentsf�.t
Use drawings iOfactbty�to better explain situations Xuseadd,honal pages as°necessary)
477 :tom „� Hea a-.:s_ -ii •--e" <„y':3,ti °- ..,--.er..yo.NYE. 3}zx ...3�.--. /.'.a Y^'+3,cviX �,',-: !� 9P°°�'4z "'°s2"�
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Mr. Loc te4r %S wer wq W'4'L- NicS
ko', C_ S St� C o,ti C e r`115 a _ S a' 1
7/25/97
d �.
Reviewer/Inspector came —
Reviewer/Inspector Signature: Date: z
it V v

State of North Carolina IT
Department of Environment,
Health and Natural Resources ` •
Division of Water Quality a
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director F.=HNI::Z A
April 3, 1997 EC V U
Samuel LockIear APR 0 7 1997
Samuel Locklear Farm
1912 Modest Road F���TEV€��
REG. OFFICE
Maxton NC 28364
SUBJECT: Notice of Violation
Designation of Operator in Charge
Samuel Locklear Farm
Facility Number 78--36
Robeson County
Dear Mr_ Locklear:
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997- Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office. -
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator.
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G.S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997.
If you have questions concerning this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
W. V
for Steve W. Tedder, Chief
Water Quality Section
bb/awdeslal
cc: Fayetteville Regional Office
Facility File
Enclosure
P.O. Box 29535. ���� FAX [phone]fi
Raleigh, North Carolina 27626 0535 � f An Equal Opportunity/Aifirmc ive Action Employer
Telephone [phone]% recycles/ 100/6 post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Samuel Locklear
Samuel Locklear Farm
1960 Modest Road
Maxton NC 28364
SUBJECT: Operator In Charge Designation
Facility: Samuel Locklear Farm
Facility ID#: 78-36
Robeson County
Dear Mr. Locklear:
FA`•`CTfEEVI►ik REG. OFFICE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919n33-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 27687, 16 *
Raleigh, North Carolina 2761 1-7687 10f An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/ IM post -consumer paper