780045_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

type of visit: IN uompttance inspection Ll Lpperation rteview V'tructure hvatuanon V iecnntcat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: O V70OArrival Time:I Departure Time: O.' County: PPXCI OW Region: t7
Farm Name:V-124_ �%1/�iVS ��" �0 _„ Owner Email:
Owner Name: _ ,s��% gy/�1lJS Phone:
Mailing Address:
Physical Address: rr
Facility Contact: 1,1 AJ21 }' z!�—✓A7VJ Title: r Phone:
Onsite Representative: Integrator:iS�i4'CjF
Certified Operator: 54-41Dy GN*iVS Certification Number: 12922
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
E
Design Current
sign Current
Design Current
Swine Capacity 'Pop.
Wet.Poultry Capacity Pop.
Cattle ,
CapaciIYVIRPNOP.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Z
I/D
;'
Dai Heifer
�r
Farrow to Wean
" Design
Current
Dry Cow
Farrow to Feeder
D =1Pon1 . N Ca aci
11.avers
P,o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPullets
r
I Beef Brood Cow
"h �!I
Turkeys
Others
Turkey Poults
Other
Other.
_
3=
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 P No ❑NA ❑NE
❑Yes
MI
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
`r' No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
[:]NE
❑ Yes
7 No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - I Date of Inspection: 3p UV 2,9 /
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 Y] No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,% l zp
Spillway?:
Designed Freeboard (in): 119
Observed Freeboard (in): W
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA 0 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? E] Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA [] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ 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): '&ll4Ul t4DA
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
T®
❑ 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.
T�
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
21412015 Continued

Facility Number: - Date of Ins ection: OIVOV
Zd/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA ❑ NE
25"Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
( No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
j] No ❑ NA ❑ NE
Reviewer/Inspector Name: 46VT_ k 1TG Phone: 10"W?3. 4V�7—
Reviewer/Inspector Signature: Date: 31 AIpa 2.0-,0
Page 3 of 3 21412015

- e �
Division of Soil and.Water`Canservaflon .Operation Review
ion of Soil and,Water Conservation ,Complianceinspeciion
Divis
Division of Water yQuahtyr- ,Coihp. anCe'IILSpeCtlOn
Other Agency on'-
Review` Z- r a r
_ N
JID
Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other -
Facility Number Date of Inspection
'Time of Inspection lA hr. (hh:mm)
© Permitted Certified © Conditionally Certified 13 Registered ['] Not Operational Date Last Operated
Farm Name: '�0Caunty:..... �®5 ....................................
--........... .....................................
Owner Name.....a.!^.u�.t................ G i� rx v� 5...................... Phone No . ......Z..".�i..1��...............................
Facility Contact: .........V..WI n.r . ......................................... Title: .................... .
Mailing Address: ......... �..��.�.....{!�.!.at`.1.L'...4s.....14,�,..................................
Onsite Representative: ................. ...........
Certified Operator: ..................................
Location of Farm:
PhoneNo:.. .................................................
......................... ,�7�r.3..a
�...
Integrator: ................. j~ S .S ....................................
Operator Certification Number: ....................... ..................
...................... .......................................................................................................... ..................................................................... ........ ............. ........................... I .......... ..........
Latitude Longitude
_.
Design Curren# Design Current-` _ Design Current
Swine ; -Capacity Population . Poul#ry, .-:Capacity.: Population Cattle - Capacity Population
❑ Wean to Feeder
Feeder to Finish
170
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ar Lagoons-
ls'1 Solid Traps
R1 ❑ Layer
_
U Dairy
1, 111Ngn-Layer
=;
❑ Non -Dairy
=�. ❑ Other
Total Design Capacity_
w
TotaUSSM ... C
Subsurface Drains Present j❑ Lagoon Area I
❑ No Liquid Waste Management System
Discharges & Stream Ibis
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 inan-made?
h. 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)
Spray Field Area l
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2
Identifier: f 7 /r kip�'' r/
/ L aIf
Freeboard(inches): ............................f .....................................
Structure 3 Structure 4 Structure 5
[:]Yes fl�.No
❑ Yes kfNo
❑ Yes X(No
❑ Yes fNo
o
El Yeso
❑ Yes
❑ Yes �&No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
Continued on back

Facility Number:7f(- Date of Inspection®
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�`No
(If any of questions 4-6 was answered yes, and the situation poses an
/
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenancehmprovemcnt?
❑ Yes
No
8.
Does any pan of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
UMo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11.
Is there evidence of over application? essive Ponding ❑ PAN
❑ Yes
KNo
12.
Crop type 8ervvuAJ_,,7Zk,+
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?
0 Yes
❑ No
15.
Does the receiving crop need improvemert?
kf Yes
❑ 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 readily available'?
❑ Yes
ANo
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
KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
,4 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑Yes �No
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative? ❑ Yes 0No
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 KNo
NO -yiglatigris or &fidendie were jui0 ed• il(Wing #his:visit: • Yoir Will-eeeeiye Rio fui t� k .. -
rorrespondeirce. a ib" l this visit
l� a) Ned 4 Ise `techA;c-A
evifte ipi Dice,
l Nee q ale -Seed C j
rs,,Ut ld /he done- Ljf-K,h
S(1CG. a4 �i ST SiAW O_OP_eS per ftca a.._j frpUl de
jwi`E'I. aA o�e)ic�,'n weed acrQs.
Y l
O_" W1°r w� . �0. — %01% J'va. 5 r` r. t tea( nti e
1-�e Ae + l0 d s .
Reviewer/Inspector Name @,
Reviewer/Inspector Signature: Date: S-`i"f
... +�V 3/23/99

I/
Facility Number. 7 — Date ref Inspection Z4
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
O(Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Wo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
XNo
30.
Were any major maintenance problems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
Z No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
DINo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
VYes
❑ No
_ d tion - onimen4 an or rawtngs a - r a . _ . . t _
3/23199

Brock Equipment Co.
Po Box 100
BAILEY, N.C. 27807
Phone [phone]
Fax [phone]
1;
' I *t8 am
DWO
6-23-99
This irrigation system was designed for Sandy Evans by Shane Ward of Brock Equipment
Co.
A scaled drawing, required calculations, and required specifications on pipe and equipment
are included.
The following buffers were maintained on this farm:
25 feet from ditch
75 feet from surface water and perennial streams
25 feet from property lines
200 feet from residence
100 feet from well
All comments and recommendations are appreciated.
Thank you,
Shane Ward
Lee Bro , Technical Speddist

P"4 A
It,
INN
tF
vp
cn
CL
IL
CL
Al
V
*21
C4
In
Al
..........
X�
C4, X-
C4
AF&
40 Mt
;A0
r

FIELD SPECI FICA TIONS
The lowest maximum application rate (inches per hour) = .4
The lowest maximum application amount (inches per irrigation cycle) = 1.0
This plan effectively wets 9.62 acres.
This information was provided by the waste utilization plan.

Traveling Irrigation Gun Settings
Travel speed = 2 fpm
Application rate = .28 iph
Lane spacing = 170'
Wetted diameter = 245'
Gun make and size = Nelson 150
Ring size = .86"
Operating pressure at gun = 50 psi
Operating pressure at reel = 73 psi
Operating pressure at pump = 80 psi
Arc pattern = 3300
Flow rate of sprinkler = 100 gpm
Pump power requirement (bhp) = 10
Total acres covered (effective) W 9.62
Traveler make and model = Cadman 2625 XL
Hose Iength = 1050'
Hose diameter (ID) = 2.625 "
Speed compensation = mechanical
1 877 220.5 4.93
2 127 220.5 1.13
3 527 220.5 3.56
Total: 9.62

TRAVELING IRRIGATION SYSTEM
CALCULATIONS
TRAVELING IRRIGATION GUN APPLICATION RATE
I = ((96.3" q)/(3.14*(.09*r)^2))*360lw
where,
I = approximate actual application rate (iph)
q = discharge (gpm)
r = wetted radius (ft)
w = portion of circle receiving water (degrees)
APRI[cg fflon Rate = 0.28 inches per hour
TRAVELING IRRIGATION GUN APPLICATION AMOUNT
d = (1.605*q)1(l*s)
where,
d = gross application (in)
q = sprinkler discharge (gpm)
I = travel lane spacing (ft)
s = travel speed (fpm)
Total ARplication Amount = 0.47 inc e
VELOgITY IN A PIPELINE
v = [0.408*qy&2
where,
v = velocity of water (fps)
q = flowrate (gpm)
d = inside diameter of pipe (in)
Velocity of Water = 2.55 feet oer second
IF q = 100.00 gpm
r = 122.50 ft
and w = 330.00 degrees
then I = 0.28 iph
IF q = 100.00 gpm
I = 170.00 ft
and s = 2.00 fpm
then d = 0.47 in
IF q = 100.00 gpm
and d = 4.00 in
then v = 2.55 fps

FRICTION L OSS
IN SUPPLY LINE AND/OR TRA VELER HOSE
FRICTIONLOSS IN SUPPLY LINE
FL ={(D.2083*(1001c)^1.852)*((Q^1.852)1(D^4.8656)1*(U100)J*A33
where,
FL = friction loss in supply line (psi) IF c = 150
c = roughness coefficient Q = 100 gpm
Q = fiowrate (gpm) D = 4 in
D = inside diameter of pipe or hose (in) and L = 450 ft
L = length of supply line or hose (ft)
Friction_ Doss in Supply Line =
FRICTION LOSS IN TRAVELLER HOSE
then FL = 1.14 psi
1.14 psi
(if solid set ... enter 0 for gpm )
FL = f(0.2083*(100/c)"1.852)*[(Q^1.852)/(D^4.8656)1*(U100)1*.433
Mere,
FL = friction loss in traveler hose (psi) IF c = 150
c - roughness coefficient Q = 100 gpm
Q = flowrate (gpm) D = 2.625 in
❑ = inside diameter of pipe or hose (in) and L = 1050 ft
L = length of supply line or hose (ft)
then FL = 20.65 psi
Friction Loss in Traveller Hose = 20.65 psi

TOTAL DYNAMIC HEAD
Elevation dif. from water to CL of pump-
si
1.732
feet
4
Elevation of nozzle-
2.165
5
Elevation dif. between CL of pump
and high point in field-
4.33
10
Sprinkler discharge pressure-
50
115.5
FL in pump suction assembly-
2
4.62
FL in pump discharge assembly-
2
4.62
FL in traveller hose** -
20.65
47.70
FL in supply line"* -
1.14
2.63
TDH-1 84.021 194.08
BRAKE HORSEPOWER
BHP = [Q*TDH]/[3960;Ep]
where,
BHP = power required to drive the pump (hp)
Q = flow rate (gpm)
TDH = total head the pump operates against (ft)
Ep = pump efficiency (decimal form)
IFQ= 110gpm
TDH = 194.08 ft
and Ep = 0.55
then BHP = 10 hp
Brake Horsql2ower = 10 horsepower

❑ Division of Soil and Water Conservation ❑ Other Agency M
Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection : RWI 24 hr. (hh:mm)
0 Registered ACertifled 0 Applied for Permit 0 Permitted 10 Not Operational I Date Last Operated:
Farm Name...... +.1 .pry ...... X�in,� ` .t om County :.......... ....7.UD�4...................._...............
OwnerName: ..........s'X.................... ....... Y..!lss.............................................. Phone No: ............. 9�....g.-....W.f:...................
Facility contact: ..........S ,r r5 n�;... Title: ............................................................. Phone No: ...
k.
Mailing Address: .ao...:....r�:�.�f................. ......................... .'.! !'!.S?dt....... A.!c
....... .
C f -.....
Onsite Representative: ..... ............,,,Q t� .. Integrator, ................ 5.............................
Certified Operator............ ............. , v, ......................... Operator Certification Number ,........
Location of Farm:
Latitude ` 4 it Longitude =• ' =11
Design Currents; i}esrgn ; k Current
Swine Ca acit w¢ N.: M W, x
P Y:�optilatton ':Poultry Capacity Population "Cattle h Ca pact Pa ulahuri
❑ Layer ❑ Dairy
❑Non -Layer ❑ Non -Dairy
❑ Other x "
` 4 9 Total Design Capac>Ity �a 90
Tota1-SSLW
tt „
Number of Lagoons /Haldtng`;1'onds :®
rea
'- ❑ Subsurface Drains Present ❑ Lagoo ❑ Spray Field Area Z
rya ,q p,
= -x� ❑ No Liquid Waste Management System
-...
:.,. ve .ate
❑ W an to Feeder
ceder to Finish
Q
�
❑ Farrow to Wean
❑ Farrow to Feeder
f
❑ Farrow to Finish
❑ Gilts
❑ Boars
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 ❑ 5pray 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 DV4'Q)
c. If discharge is observed, what is the estimated flaw 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?
7125147
❑ Yes ;gNo
❑ Yes ANo
❑ Yes XNo
❑ Yes M No
ry
❑ Yes No
❑ Yes fid No
El Yes �No
❑ Yes )allo
❑ Yes PfNO
❑ Yes R!kNo
Continued on back

1
f
facility \umber: �-
8. Are there lagoons or storage ponds on site which need to be properly closed''
Structures (L.wgons,11o.1ding Ponds Flush fits etc
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3 Structure 4
❑ Yes XNo
❑ Yes A No
Structure 5 Structure 6
Identifier:
Freeboard(ft).............p�..��....................t? .................................................................................................
10. Is seepage observed from any of the structures?
I. Is erosion, or any other threats to the integrity of any of the structures observed?
12.. Do any of the structures need maintenancelimprovement?
(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 tnaximunt liquid level markers?
Waste Application
14. Is there physical evidence of over application?
( �� g e, notify DWQ)
15. Crop type ...................
to excess o........i...P. or runoff entering waters o1: the State. .........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. 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 OnI.X
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''
❑ Yes
ANo
❑ Yes
IgNo
$'Yes
❑ No
❑ Yes
JX No
❑ Yes
No
.......................................................
❑ Yes
No
❑ Yes
No
❑ Yes
XNo
❑ Yes
FM No
❑ Yes
;WNo
❑ Yes
NJ No
❑ Yes
ANo
❑ Yes
XNo
XYes
❑ No
❑ Yes
❑ No
0 No.violations or deficiencies were no'tei& during this'visit. You.will receive no further
correspondence a out this visit.- .
Cottaments;(refer to.question #): Explain any YFS answers and/or iffy recntnineridations or any other cotnnients R
,Use ft"ipgs of faeihty to•better.expiain situations, (use additional pages es recressan°j:
.4zmo,,e em"n -a � - -�. ,:Uu-ei,..V�:Wn . . bjej
A
Reviewer/Inspector Name `3'r
Reviewer/Inspector Signature:
...n.:xir^- — n � _
Date: _ .5--- 07l='91E

Site Requires Immediate Attention: -- A!;%
Facility No.
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ZY , 1995
Time: _ �t !3'1
Farm Name/Owner: 5 &,cC e 4Fu, ..,s-
Mailing Address: _ .fit 4�� � - z <0_.
County: P.4esw — — — — - -
Integrator: - P,� �. - - -- _ Phone:
On Site Representative:_ Ej &4dT/�.otoe Phone:
Physical Address/Location:� 5-A2 .►ice _
Type of Operation: Swine _� Poultry Cattle
Design Capacity: aG-.4_ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ° - "
Circle Yes or No
Does the Animal Waste Lagoon h e sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Ue or No
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? Yes or No
Crop(s) being utilized: "-
Actual Freeboard:_ lFt. Inches
Yes or No Was any erosion observed? Yes or No
Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelli YWor No
100 Feet from Wells? I or o
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 0
Is animal waste discharged into water oe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or ZW If Yes, Please Explain.
Does the facility maintain adequate waste management reco(volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y or No
Additional Comments:
Inspector N e
4-1
--Ai—
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

r
.=G: c 77=N 70RM . CR rN:MIAL . _M'�r O Q== -DNS
Dena_.:e-Zt o- -Environment, r_ealt : a_zd Nat zal Rescurces
Division of Management
Nate, Quzli_y Sec=_cr.
-- :.he a ni-ga? waste maa:agemenz system you_ =eedlcz CZe_at_ar
=s
cesizned tc serve more t -ar. c_
eq-7:al to 2.00 ::ead
off cat_l e,
75
?gorses, 250 swine, _, eOC snee„
or 30, 000 �i,�s t-a_
are serves
by
a -_arid" waste sys am, t -e_^. c is
=.;� -Must ce=_i==_�
c��t a.^.G ma z e�
by Oecem...er 31; _ 9 53 aursua _ __
15A NC_iC 2 . Q2-7 (c)
__. arse= tc
be
deemed DEM. _ _ease n,:_-_ clea_iy.
Name: Wa4zr'n, L: U-1 n1S
Ads e s s
COun : *. c r��
Cs:ner (s) Name: G
Manace; (s) Name: u
=essee Name:
{q-2o
-).-,-one No.
=rm 7ocaticn (Be as s=ecif_c as nass"ble: coad names,
_ die�ion,
-cast, etc .) : L! sA t 1.
�;; n C- li5 [� aL� s- t`� G,, LI om .Iry 1 ..I.. fl- . ! r11.
rat_�ude/;cnc_t-=a i= krawn:
res_cn: cazzcit•J cf animal waste managemenz system ,(Numj er and type
C._ cznZ_ne= ar.�...a= (s) }
Average anima_-cpLlatiorI on t =a =a=..i (Nu=!:er a-nd t_r.:e of ar,4MAI (s)
�� �/� 5 q
Year P.rocuc —4 cn 3ecan: r A✓C5 1_a1c- No.
'type a= Waste Management System Used: { a=1111
ACces Ava-i a -le fzr Land An-21-C'__i^on of Waste: / -
Caner (s) signature (s) �, �'+�J�'^ /�/�,i.�"�..�..� OATS: //- !7i'�'
DATE•

ANII3.1L , WASTE XANAGEWHT PLAN CERTIFICATION FOR M W OR RZPAHDED FEEDLOTS
Please return the caasplsted form to the Division of Environmental Management at
the addreea on the reverse side of this forma.
Name of farm (Please print)s SandX Evans__
Address;
Fairmont, NC Z8358 Phone No.:1,210) 628-6498 ..,,
Countys
Farm locations Latitude and Longitude:2¢°12: W (required) . Also,
please attach- a copy of a county road soap with location identified.
Type of operation (swine, layer,. dairy. etc.)s
Design capacity (number of animals)s 4410 5 - _
Average size of operation (12 month population avg.) s 4410
Average acreage needed for land application of waste (acres)1 32 _
sosaaasrsrsrsaasssssasrssssssrsrsrarsrssssrsssfrrasrssrsssarsarrrsrrrsssrsrsr�
Technical SPacialiat Cartificatian
As a technical specialist designated by -the ;North -Carolina Soil and Water
Conservation Commission pursuantto15A NCAC 6F .000S, I certify that the new or
expanded animal waste- management system as installed' for the farm named above
has an animal- waste, management plan that meets the design, construction.
operation and maintenance standards and specifications of the Division of
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to 15A NCAC 2H.0217 and
15A NCAC 6F'.0001-.0005. The following elements and their corresponding minimum
criteria - have been verified by me or other designated technical specialists and
aze included in the plan as applicable: minimum- separations .(buffers); liners or
equivalent for .lagoons or waste .storage ponds; waste -storage capacity; adequate_
quantity and -amount of land for waste utilization (or use of third party) ; access
or ownership �of proper waste •application equipment;•'schedule for timing of
applications application rates; -loading ratesf and the control of•the-discharge
of pollutants -Troia sto=m-iater.runoff events less severe than the 25-year; 24-hour
storm._
Name of Tecbaiea2 Specialist (Please Print):Ed Holland
Affiliation: Soil Conservation Service
Address ..(Agency) : Lumberton NC .Phone No.739-5478
Signature Dates " ¢
ssasrs„ssarr�,arrrr ��srr��stsaa�.r.aswrsaasrr.s�sssssssss s �:r�a.rraaa
Owner/Kanager. Agreement
I (we) understand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures.;` I (we), know that any additional -expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25--year. 24-hour stoma. The
approved plan will -be filed at the farm and at the office of the local Soil and
Water Conservation District..
Hasse of Land Vwnar f lease . nt) s ,-]fAJV ❑ 7 A , VAAUS
M z2 — Date s
Signature:
Names of Ssnagar, if Wf€erent from owner (Please print) s
Signature: • Date:
Note: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer.
DEM USE ONLY:ACNEWO

IN
Type of Visit (afCompliance Inspection Q Operation Review (!!Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint eFollowup Q Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: (? Arrival Time: fs 60 Departure Time: o`IL-1 County: Region:
Farm Name: —Ua4Afr Owner Email:
Owner Name: -�� ''ti0'IL Lva Phone: '4
qv
Mailing Address: 130 a4r�.d%ZI/
Physical Address:
~
Facility Contact: L_ tA,&1 1;?Ja't-S Title: ,Cra`oW11a./- _ _ Phone No: WO —71O"0W
Onsite Representative: _ SA I & V A S-- 1 rZ=' Integrator: qq
Certified Operator: Operator Certification Number:
Back-up Operator: G- l a--j Back-up Certification Number:
Location of Farm: Latitude: o Longitude: = o u
Design Current11
"hill
Design Current
1:11CA—A&Ig
Design
Current
ne
rRoRean
Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity
Population
ean to Finish
❑ La er
❑
Dai Cow
to Feeder
❑ Non -Layer
❑
DairyCalf
❑ Feeder to Finish
o
-
❑ Dai Heifer
❑ Farrow to Wean
©ry`Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑Non -La ers
❑ Pullets
El Beef Stocker
❑ Beef Feeder
10 Beef Brood Co
❑ Gilts
❑ Boars
❑ Turkeys
Otber
❑ Turkey Points I
❑ Other
e .
Number of Structures:_`'
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of th operation?
a6es
El No
El NA
[I NE
Discharge originated at: Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
2 o
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
VNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
/
&'N' o
ElNA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
[1Yes
UNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ZYes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facili Number: 7e -0 Date of Inspection: 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [R fes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes 214o
Structure 1
Identifier: OI d
Structure 2 Structure 3
1jr[A)
❑NA ❑NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): t„ .�! t
Observed Freeboard (in): 027S _ r t' w
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Yes ❑ No ❑ NA ❑ NE
Yes [—]No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [f Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application �e
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes E.'No [DNA PTNE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [RtE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
IE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
lgE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
I rJ lei
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
VE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
M E
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[ZVt
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
VE
Page 2 of 3
21412011 Continued

Facility Number: - jDateof Inspection:
* 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
❑ NA �E
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ❑ No
❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes ❑ No
❑ NA EB' lE
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 ❑ No
❑ NA E3,X15'
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA C3'14E
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No
❑ NA B<E
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[3' 1E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
[Erl�i
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
Cq<E
�NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary),
CP�4_P of
6�S<.---V jr
0*-ks 10wvY KY 4--,
Y
o t,k 1l13
A, �J � � e s
t � rev- �
1� di'tr'd-ri ad 1(
i1jt. f�Gu � K�vo+1
Iev tJtzS4kPPrviu. 2-1
.
.� ki te4L It 7,
1�� ���1,2S s�F-
ScGr fA Ckt- V cc fwZ ,&� `�c_ Ns f �,,, cr.
r
c s w� � , ..�►�`�rwec � `tw o [y nv+�J
r A, � j
40
l 5 e
GIB CIi� *k!�U �S�T�> s�rrnrti StM��ar's-�T5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone. 3
Date: u
2 ofI

N
Division of Water Quality
Facility Number ®- p S O Division of Soil and Water Canservatxon
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review, 49Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
.. L&J_ L - I j ---
Date of Visit: J6QAbj Arrival Time: t O Departure Time: Qd County: gobtS6-r-
Farm Name: S-t U- l l Owner Email: z
Owner Name: /, Phone:
Mailing Address:
Physical Address:
Facility Contact:
ttti 4�Ct 01'ty Title: ft.1kt1 ZkA
Onsite Representative: f( Integrator:
t�
Regio
ro
U L( ')r"4gtr _
Phone: �f O - -7 ` 0 ' � -1l
Certified Operator: . 4 4—S Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current =
Design Current
Swine
Capacity Pop: - 'Wet Poultry
.,�
Capacity
Pop
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
�:,,
Dairy Calf
Feeder to Finish
1% p - jl
Dai Heifer
Farrow to Wean
,
Design
Current
Dry Cow
Farrow to Feeder
D - 1?oUl Ea ati P,o .
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
i _ Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
L 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No [DNA g]NE
[::]Yes [] No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
[]Yes [] No
[-]Yes [-_-]No
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
DINE
❑ NA
gNE
Page 1 of 3 21412011 Continued

i Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ErNNo
[] 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): -► 7 �`
Observed Freeboard (in): j `(p
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 noq 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?
es
❑ 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
[j�[ 1 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
14E'
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
�; E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [] No ❑ NA ET<E
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA [;' —
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA `g —
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA Q�KJE
❑ Yes. ❑ No ❑ NA [4,A'E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA EKE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:]No ❑ NA EKE
the appropriate box.
❑WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA [](NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA E�/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
No
❑ NA B-71E''
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
[] No
NA Q'NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey Failure to develop a POA for sludge levels
0 Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
❑ No
NA E'1gE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
No
NA �lE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
Yes ❑ No ❑ NA
NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No NA
�1E
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
Yes No NA
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes No [] NA
[3-NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
Yes No NA
[ 1f4E
34. Does the facility require a follow-up visit by the same agency?
0 Yes No NA
C;�<E
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.— 4
Use drawings of_facility to better explain situations (use additional pages as necessary).'
D ('-t 4ol,
Plo -k-e^ C,,,L k^4� I --t_ tz e-- Ce
S
tt,t1( wcj Gor�
6^�CGLt^ � t k
Reviewer/Inspector Name:
ReviewerlInspector Signature: Y,
Page 3 of 3
Phoneov 0-
Date: b U%
2✓412011

Ir
4hq
Type of Visit: CYCompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: CYRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i4 1 Arrival Time: pM, I Departure Time: I 1 1130 PMI County: gbEc�
Farm Name: zgrvpy �ugYV S Owner Email:
Owner Name: gt��0y_ _ �V Ar�S Phone:
Mailing Address:
Physical Address:
Facility Contact:
ks"()A f U AN5 Title: Cd. Q W A F_<
Onsite Representative:
Certified Operator: gAHQs f:yfir s
Region: FRa
Phone:
Integrator: figLs {A-g
Certification Number: 17 o�Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current " .'
Swine Capacity 'Pop. Wet Poultry Capacity Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 1&10
tcA
Layer
Non -Layer
Dairy Calf
Design Current ` :
Dr, Poul. C•_a acity P,o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Uthe
keys
urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [EfNo ❑ NA ❑ NE
[:]Yes ❑ No [5NA ❑ NE
❑ Yes ❑ No RrNA ❑ NE
❑ Yes
❑ No
❑ Yes
eNo
❑ Yes
dNo
E�NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

facility Number: " 1% - t) J jDate of inspection: Lit\R
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ['��Rlo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ETNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Li 07
Identifier: q'�Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r 8
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E�fNo ❑ 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 [trNo
❑ 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 DNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [-]Yes ❑ Wo
❑ 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
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [::]Yes [yNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ff 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 Acce table Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): tRIVN.') 01:+ AZE • )
13. Soil Types): rAbRV;W_ Rq 9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E+ f No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes EdNo ❑ 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 [J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes Ej No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design []Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [ti7 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
MINA ❑ NE
Page 2 of 3 21412011 Continued

i -+
Facili Number: 113ate of Inspection: 4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ("No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ErNo ❑ 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 [2rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2% ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2+ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[✓fNo
❑ 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
[TNo
❑ 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.
D Yes
E]�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative"
❑ Yes
NP4o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]�No
❑ NA
❑ NE
.a y�aAm
Comments (refer to question. Explain any YES answers and/or any111.­
addttionaKx commendationsor an other com
lUsedrarvins of facility to better explain situations (use additional pales as necessarF). ,
Caodo v7AR "1
kCxpj W &AN
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '3I0-3C&—(o95
Date:
21412011

Type OI v]slt: f4p Compnancc Iaspeenon V Vperauon 1(evmew u Jrructure L vaination iJ l ecnnlcal Asslsrance
Reason for Visit: * Routine O Complaint O Follow-up Q Referral O Emergency (:) Other 0 Denied Access
Date of Visit: 7 I Arrival Time:j g:4fypr'VSj Departure Time: al: County: RobzgVo-/ Region: f12O
Farm Name: Evans Owner Email:
Owner Name: Z Ar%+D�:l E V A+.*S _
Mailing Address:
Phone:
Physical Address:
Facility Contact: kxn04 EUAA,5 Title: Phone:
Onsite Representative:
Certified Operator: 0gnl/,yyt/Ic�NS
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current : Design Current
Swine Capacity PopPoultry Capacity Pap.
Wean to Finish Layer
Cattle
Design Current
Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean;
Y �
'"+ Design Current
l) KPoult y a aci P.a ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Fullets
Beef Brood Cow
-01 Other
Other
Turkeys
Tur-ey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [2/No ❑ NA ❑ NE
[:]Yes ❑ No VNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes
❑ No
WIA
FINE
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
[13"'NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ed,
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - 0q( Date of Ins ection: 7 hS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[fNo
❑ NA
❑ NE
S ructure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
��J a
Identifier: Q� d
^�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3"No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
]/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes EV 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 [Z/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [+rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [EfNo ❑ 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 Acce!pttable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
/e�
12. Crop Type(s): �Pl0,M L, 01A � GR A2 F, � ZfnA l I GAA]1t1 0 ue Rseeo
/ _
13. Soil Type(s): NOR �R �,J f� Q 9 A w+
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []v No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes v❑rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Cg No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[v(No
[DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[g"No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2r No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No E�(NA ❑ NE
Page 2 of 3 21412011 Condnned
/A

Facili Number: "I - a 1 1 Date of Inspection: '7 5 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [E�No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes dNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E�No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [df No
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 E2rNo
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 gNo
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 ErNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Cg�No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [�
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any other comment`s:' I �
use..drawings`of facility to _betf&-explain situations (use additional pages as necessary}.,
kzc.GR�)S PARS Kest IJ��1
VpArn 1'00:S CoC3D
Reviewer/inspector Name: t 5.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1310-1433-1330'
Date: "7 f [51,90 t
21412011

Bsw[s S—n el —20/D
Type of Visit ompliance 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: —15 /O Arrival Time: Departure'Time: County:
Farm Name: _ N �U-5 % Q!_Z _ Owner Email:
Owner Name: s� `r°lyi/Qivs Phone: _
Mailing Address:
Physical Address:
Facility Contact: 4- +,j EVLW S Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Region: I'- /Z40
Go — O u3 n► t.1�
Phone No:
Integrator: -F>,51�,, F.'r'"_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = A =,; Longitude: = o = i = if
Design
Current ggDesign Current Design
Current
Swine Capacity
Population Wet Poultry Capacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -La er
I
❑ Dairy Calf
® Feeder to Finish /2 70 1
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
❑ Gilts ❑Non -La ers
❑ Boars El Pullets
ElTurkeys
❑Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
the ❑ Turkey Pouets
❑ Other ❑ Other
Number of Structures:
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 3 o ❑ NA ❑ NE
❑Yes ❑No C NNAA
❑NE
El Yes ElL`� No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes[.3,'No�❑ NA
❑ NE
ElL_`fYes `No ❑ NA
❑ NE
Page 1 of 3
12128104 Continued

_y
Facility Number: 76? — 0Date of Inspection -iS-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 8<. ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t9 — 20
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes B< ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �,�
6. Are there structures on -site which are not properly addressed and/or managed El Yes CINo ❑ 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 Ek o�❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElE Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes �}' '1Qo L❑ NA ❑ NE
I L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [I Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop tYPe(s)ea-w«. dos ( 6+-• 9c 11
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18_ Is there a lack of properly operating waste application equipment? ❑ Yes
I_'TiVo ❑ NA
❑ NE
0_90�13 NA
❑ NE
O'No ❑ NA
ElNE
ag.g❑ NA
❑ NE
No ❑ NA
❑ NE
Reviewer/Inspector Name - 0 = Phone: 9/D. 5(. , 33 60
Reviewer/Inspector SignatuDate: T /SrZC/0
Pine 2 of 12128104 Continued

Facility Number: 78 - Date of inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El 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 V
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
<No❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Lf No ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NA
;;No�0,0
❑ NE
26. Did the facilityfail to have an active) certified operator in charge?
Y P g
❑ Yes
L1�NNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
QNo ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 Na ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�k<o❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Page 3 of 3 12128104

1B1,,�j5 , Lc,e4 5 -1 S-zco 1) 2P—
vision of Water Quality
Facilitty Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit &compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: g; a0lks... Departure Time: // %35 County: �D�aA/ Region:
Farm Name: fat-i C A Eva.f 5 rt 9 r Z0 Owner Email:
Owner Name: _ Q,�l d i., E r-m s Phone:
Mailing Address:
Physical Address:
Facility Contact: As >f i Audo`. r1JaN S Title: ail'vQ�Vr Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 =di Longitude: = o = 0 =
44
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑
Wean to Finish
❑
Wean to Feeder
IN
Feeder to Finish
/270
S
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream ImAaCts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy heifer
CrDry
Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
_-f
Number of Structures: »�
h. 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 2Y16_ ON E
❑ Yes
❑ No
E tvA
❑ NE
ElYes
ElNo
BA
❑ NE
[9NA
❑NE
❑Yes
El Yes
E❑NNoo
o
❑ NA
❑ NE
❑ Yes
3,90
❑ NA
❑ NE
12128104 Continued

Facility Number: 78 — ifs Date of Inspection 29-0 g
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ E Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check [:1 Yes BN* o ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21 _
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
17N0
❑ 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
2<o
El NA
El NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El
o
IjNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,�o
L-'_j o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 2o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (R<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3<
❑ 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
,�,�
[3 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,�
3 1 . Did the facility fail to notify the regional office of emergency situations as required by
El Yes
E o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
��.,��
I+� No
[INA
[INE
33. Does facility require a follow-up visit by same agency?
ElE Yes
No
❑ NA
❑ NE
Add itsanalaComments L and./ r'Drawings "
Page 3 of 3 12128104

Facility Humber: Date of Inspection -29-DQ
Waste Collection & Treatment
�/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElE Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
B<o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: /?_7_0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3111
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
B'5o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0to
❑ 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
[9'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElE Yes
��iv
o
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2 o
❑ 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) ��►..�.�d �. C/tvya e5in-"V tlQ,5
11 Soil type(s) No A' UaS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
L�`J oo
❑ NA ElNE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
LI No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E YN_o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[ No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
E3"1Go
❑ NA ❑ NE
Reviewer/Inspector Name Phone: g/0,4433r 333�,%
Reviewer/Inspector Signature: 1.�.Gc� Date: �f' Z9J - 7
rage., OJ 3 I'dAM104 c,onnrruea

: js it(S .9-0,{-0,8 Rp— -
r
Type of Visit 42Mompliance 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: 1 Arrival Time: Departure Time: County: leg eroW Region:
Farm Name: _ _T, ",Ws; E✓� % 9 r z0 Owner Email:
Owner Name: S Phone:
Mailing Address:
Physical Address:
Facility Contact: S Zi..'dw ✓G-/5 Title: d,7UJ UGr 'S /PPhone No:
Onsite Representative: _ � - ✓�ws z�. 4 5 Integrator:._ /�'�7��cs�_ /�r�e•r
of
Certified Operator:Operator Certification Number: /% SZ q
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e =' = « Longitude: E—_1 o =, =
Des gn Current
Desgn Current Design Current
Po
Swine
Ca aci Po elation
P t3' Pry
Wet Poul Ca aci 'elation Cattle Ga aci Po elation
P:hP h P
.P.
❑ La er ❑Dai Cow
❑Non -La er ❑Dai Calf
airyHeifer
Dry Poulr ❑ D Cow
try : {�
&FRO.."
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to FinishJT
❑ Farrow to Wean
El Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
ElNon-La Non -Layers
❑ Beef Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
0-Turkeys
-
❑ Turkey Pouets
❑ Other
❑ Other I Number of Structures:
Discharges & Stream Impacts
/��
1. Is any discharge observed from any part of the operation?
El Yes
No L9 NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No [I —NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No E NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
,{
❑ No LI NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Now❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
El2
3
'fio ❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104 Continued

Y �
Facility Number: 71r- zf� Date of Inspection
Waste Collection & Treatment
��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
❑ NA
[I NE
a. If yes, is waste level into the structural freeboard?
El Yes
?No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in): q-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
lJ 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
[3 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
�] Yes
,--�,�
t•T No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LJ No
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �SVo ❑ 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. Croptype(s)�a►��;Ie� _S �a,i✓^ i O.S.
13. Soil type(s)--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �ff'Ro El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El ETNo No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ElYes 0-115"❑ NA ❑ NE
Reviewer/Inspector Name � j' L - I Phone:
Reviewer/Inspector Signature: Date: 7—ZZ-240�
Page 2 of 3 12178104 Continued

a,
Facility Number: 7 T--1�, j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropirate box.
❑ WL3P [I Checklists El Design El Maps El Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. El3 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 ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q o
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Go
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Flo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,�o
L7, N/o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
���
fNNoNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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?
El Yes
,�,�
EJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ETNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Page 3 of 3 12128104

f ® Division of Water Quality
Facility Number '%$ �f O Division of Soil and Water Conservation
O 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 O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: PTWO Departure Time: Z;a1 County: Region:
Farm Name: .J,S 9 `Za Owner Email:
Owner Name:!;aNdc. i✓V�� Phone: 910 191, 4�1 W9Sr _
Mailing Address:
Physical Address:
Facility Contact: _ SaAj(dh ttJ57✓Q-45 Title: OweJe-41' Phone No:
Onsite Representative: LIntegrator: Pr-05_ :Ll, �,rS
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede3
Farrow to Finish
Boars
Other
❑ Other -
Back-up Certification Number:
Latitude: [= 0 ==61 Longitude: 0 0= 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity :Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
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 [9 No ❑ NA ❑ NE
❑ Yes
�fl No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[9 No
❑ Yes
q No
❑ NA
❑ NE
❑ Yes
q No
❑ NA
❑ NE
12128104 Continued

Facility Number: %g—$
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm•storage plus heavy rainfall) less than adequate? ❑ Yes Qb No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[� No
El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
I
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�] No
El NA
El NE
through a waste management or closure plan?
1
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
t] No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
No
El NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i 0% or I01bs ❑ 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) ! v &, 1,Si C rn/ �Si
13. Soil type(s) Wc4 ' Al
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fj No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ir
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes EN No ❑ NA ❑ NE
17_ Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/inspector Name tjCt, phone; 9J0.33,333b
Reviewerlinspector Signature: J Date: S— 4 %— ZOO
12128104 Continued

Facility Number: % 9 — s Date of Inspection S 67-p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z 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 El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 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
Fil No
pla
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JONo
❑ 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
1M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(] No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional. Comments .andLor°Drawings:'
Page 3 of 3 12128104

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: '. (J� Departure Time: ' 3� County: 6-570^J Region:
Farm Name: sa N J !4 6- v S „ 1 — Z O Owner Email:
Owner Name: Etta AuS Phone:
Mailing Address: t
Physical Address: Facility Contact: Sa"d E'U Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: /`reSl S C�_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 6 a « Longitude: = ° = , = «
Design Current
Swine Capacity .Population
❑ Wean to Finish
Wet Poultry
❑ Layer
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish Z% /z
�"' `' ' ' '
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry,
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non-Daiiy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Pouets
10 Other
Number of Structures:
J
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q§ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
1ANo
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
0 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[A No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[29 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

L
Facility Number: Date Inspection -I
of
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[N No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
� i
Designed Freeboard (in): _ L
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
IN No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J0 No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
R?No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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.
Croptype(s) LACtS„l �cr�•rc�dc�,it/r�ty SLaygcc✓NttwC
_
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
VFNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
V9 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
1PNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
P No ❑ NA
❑ NE
,Comments (refer:to question #): Explain any YES answers and/or any recommendations or any otherr�comments
Use d.rawtngs.of facility to better explain situations: (use additional pages as necessary):YrK } ,.
Reviewer/inspector Name z + I e�!'G� .- � Phone: 9`/a I/K? -33o0
Reviewer/Inspector Signature: dig Date: 7-/V-
Page 2 of 3 12128104 Continued

I
L
Facility Number: 7 g— C 1 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 ❑ Checklists ❑ Desig
n El Maps El Other
❑ Yes 09 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (icl discharge, freeboard problems, over application)
32_ Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[%No
❑ NA
❑ NE
❑ Yes
191 No
❑ NA
❑ NE
❑Yes
1�No
❑NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA [:IN E
Additional Comments and/or Drawings: + -
Page 3 of 3 12128104

f
Type of Visit (?<o—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ��/ Arrival Time: Departure Time: County: ✓ Region: FER
Farm Name: s Z%C—,2 D Owner Email:
Owner Name:' /�d6Y-r t I _ Phone: 47— to
Mailing Address: /3 D�!L Ina 4 txro�
Physical Address:
Facility Contact: irTitle:
Onsite Representative: -�
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 1 = Longitude: = ° = 1 = u
Design Current
V
Destgri ; "CurrentCurrent
Swine
Capacity Population
j Wet Poultry
Capacity Population
Cattle Capty Population
❑ Wean to Finish
❑ La er
❑ Non -La er
❑ DairyCow
❑ Dai Calf
ean to Feeder
kF� eder to Finish
p
IL
Dty Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
` Li Dairy Heifer
❑ D Cow
❑ Non -Dairy
El Beef Stocket
' El Beef Feeder
El Beef Brood Co
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
FE]Gilts
Boars
Others
-.. _
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
jo No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
® No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (I f yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[ANo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

I
Facility Number: J�-# I Date of Inspection Sr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fNo ❑ NA ON I,
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
X 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
[gNo
❑ 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
[4 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 Dyes
[KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C.No
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
�offArea
12. Crop type(s) _f_44o"5 � 'r/JZ�i�4 ! r21iTr��r
13. Soil type(s) Wz
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JKNo
❑ 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 determinationi[f
Yes
2 -No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Et -No
❑ NA
❑ NE
Comments (refer to,geeshon #) Explain any S atxswers aadloranreotmm�dat�oas or any oMerlcomments.
Use drawings of fac�ty to better eaplam si#uahons. (use additional pages astaecessary):
1
Reviewer/Inspector Name v j i�3 ..per 7W Phone: %/a—
Reviewer/Inspector Signature: Date:
1212 /U4 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19_ Did the facility fail to have 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 appropiiate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JgNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[0,No
❑ NA
❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
�KNo
❑ NA
❑ NE
❑ Yes
C2-No
❑ NA
❑ NE
❑ Yes
V[No
❑ NA
❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
12128104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ®Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number date of Visit: � Time:
rON otOverational ORelowThreshold
®Permitted ®Certified /0 Conditionalli Certified Q Registered Date Last Operated or Above Threshold:
Farm Name:✓� rya..�1 /f — 2c5� County:
Owner Name:-�� Phone No: ���✓ �� _ riJ�rf'�
Mailing Address:
Facility Contact: �/�� �vA `�� Title: Phone No:
Onsite Representative: ✓� � Integrator: Z
Certified Operator: �'' '��� Operator Certification Number:
Location of Farm:
❑ Swine ❑ Pouttry ❑ Cattle ❑ Horse Latitude 0' '^ Longitude �' 0
-'Design Current
_Sviinie _ Ca acih Population
❑ Wean to Feeder
® Feeder to Finish /z 76
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
--`:Design Current Design Ciirrea#
ultra _ -_ C' actty -Pa' ulatioa Cattle _"Ca apty = PO utstron
Layer ❑ Dairy
LI Non -Laver ' ❑Nan -Dairy
❑ Other
=Total Destgn .Capacih
Toti l SSLW -
Nutttbet of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area;;
Holdrag:Paa�is`/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav 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 floe in gal/min?
d" Does discharge bypass a lagoon system? (If yes, notify DNN'Q)
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 S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
294
❑ Yes # No
❑ Yes ( No
❑ Yes No
❑ Yes [,RNo
❑ Yes No
❑ Yes No
❑ Yes F.No
Structure 6
Continued

Facility Number: 1' — YJ--
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �F,P .� �fo _ .11-1 f�
❑ Yes J�IrNo
❑ Yes N-No
❑ Yes ,® No
❑ Yes allo
v
❑ Yes 0 No
❑ Yes ER No
❑ Yes M No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes -N1 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Ej No
b) Does the facility need a wettable acre determination? ❑ Yes [-UNo
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AA' -MP?
❑ Yes ONO
❑ Yes URFNo
❑ Yes (ONO
❑ Yes [R:No
❑ Yes RNo
❑ Yes WNo
❑ Yes E5 No
❑ Yes 5QNo
❑ Yes No
❑ Yes No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments;(refer � -
- ;guesrtioia #) E:iplsuy ail YE5'snswei s antlJar an; reeamrnenda0ous,areny other ca_mments. '-', �--_ ^�
� _
Use'drawtngs of fa.�eilrty to brtter�ezplat:i situattpns: (ase'a�didonal pages ss aecessary) s [] pield Conv � ❑ Ftnai Notes �
y�icf'Zi¢
/ :',c,�
o�cAf`'r !//.E�✓�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: -t
O5103101 Continued

Facility- Number: hate of Inspcctinn
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below (XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [RN.o
28. is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [!� No
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s), inoperable shutters. etc.) ❑ Yes MNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes aN0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
05103101

-ram _.{. .. 1.:... .•-diGit _'..ti. '..L y�fi,'F- f"t.v.Fl �� _ _ -'^v. y _
___
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
pate of \'icit: A i=acilin� lumber Time:
Not O erational 0 Below Threshold
Permitted ® Certified [3Conditionally Certified D Registered Date Last Operated or above Threshold:
Farm Name: g - o County: _ � c 1J�Scr
07
Owner ]Name: C+ Phone No:(_4g8
Alailing Address: j 4 S ar e +c,_ _-koe.� �' G.
Facility Contact: _d. Title:
Onsite Representative: r
Certified Operator:
Location of Farm:
Phone No:
Integrator- Q
Operator Certification ?Number: 1�
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 0u Longitude ' •
Design Current
Swine Canarity Pnnnlatinn
❑ Wean to Feeder
11 Feeder to Finish
O
❑ Farrow to %Vean
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I JE1 Dairy
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons _L i I ❑ Subsurface Drains Present 00 Lagoon Area ❑ S ray Field _4rea
Holding Ponds / Solid Traps I ❑ No Liquid Waste Management Svstem ,
Discharees & Stream Imparts
I _ Is any discharge observed from any pan of the operation?
Discharge orininated av ❑ Latxoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b_ If discharge is obsen-ed, did it reach Water of the State? (If yes. notify D WQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (itucbes): 33
05103101
❑ Yes W No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
No
❑ Yes
[Q No
Structure 6
Continued

Facility Number: Date of inspection 11112
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes I] 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 qNo
(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 1ANo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes " No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes U No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [g No
12. Crop type R P 1' rv% I J, A
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
QNo
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
[9No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ER No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[0 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
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
v.aiv.nvl

.. .
Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan 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?
O5103101
❑ Yes ❑ No
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No

Facility Number Date of Visit: �� Time: a
Q Not Operational O Below Threshold
Permitted 0 Certified 13 Conditionally Certified //[3 Registered Date Last Operated orAboveThreshold:
Farm Name: ___5p', n. . ...... . /...J.. ~Z� County: ......
Owner Name: ............. ... Phone No: .p��,��
.............. !J..........._....................... .... .......�
Facility Contact: ..Q...4i,?[.1.L�.�._..._W...---,_W_. Title:............................................Phone No: ...................._....._..._....__.....
Mailing Address:...,�.,Q
Onsite Representative: .......... Integrator: ............
Certified Operator t/Q4 SOperator Certification Number: ._
Location f Farm:
❑ Swine ❑ Poultry ❑ Cattle [)Horse Latitude ' ° 64 Longitude
Design Curr`eint
Swine R,. - :.['anarity Pnnnlatiriii
Wean to Feeder
eederto Finish
Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
Boars
Nunnber:i-f oohs ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
M.
Holdtig Ponds / Sohd Traps;: No Liquid Waste Management System
Dischames & 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?
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
SLruct re 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...... lP2_......... fu�.............. .....
Freeboard (inches): / 3 7
5100
❑ Yes Ir
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes J�No
❑ Yes 4No
❑ Yes RNo
Structure 6—
Continued on buck

Facility Number - Date of Inspection �4
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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aaalication
10. Are there any buffers that need maintenancelimprovement?
I I - Is there evidence
Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop hype L(d0. {l Q f / ,�sr. 6
13. Do the receiving crops differ with those design -fed in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c)'Ihis facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Plan (CAWMP)?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.: •YiAigtis.o dgf##cieuc�e�'K`�re P�:�• �1H`}ng �ls:�i� • Y;o� w�•r; ec�iye l�o fu4'�i't:::
-�•�ori�espotidence:aboutthisvisih..-.- -.-.-. ..•.•.•.•••.•.•.•.• -..
❑ Yes XNG
❑ Yes �No
❑ Yes )kNo
❑ Yes O(No
❑ Yes gNo
❑ Yes 9No
❑ Yes XNo
❑ Yes JKNo .
❑ Yes %No
❑ Yes CgNo
❑ Yes KNo
❑ Yes KNo
❑ Yes XWo
❑ Yes W No
❑ Yes 14 No
❑ Yes fi(No
❑ Yes Wo
❑ Yes j4No
❑ Yes A� No
❑ Yes WNo
❑ Yes J rNo
❑ Yes
04.,E . gaS4b 14 rgSS a,%__ �vP
l�.� J41�-i'���►.� t ca i s�peQ1a�'J� 4V Aawe_ _rm'11 �" i d Ou!r'Se�I in Cc"/
C6>4t5 '4 I _r,. e. jj I" & ve r� 9OOJ •
Reviewer/Inspector Name
Reviewer/taspector Signature: Date: 0 5100

Facility Number: y Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
-liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes q<o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 4N0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Wo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? )KYes ❑ No
5/00

Facility Number 7 Date of Inspection 0
Time of lnspection 24 hr. (hh:mm)
[] Permitted [3 Certified Q Conditionally Certified © Registered 13 Not U erational Date Last Operated .
FarmName: 5 /��.Z .......................................... County: ........ Z_4 ...... -.:`.......................I........................
Owner Name:........... .•J za /d G2'— G
.............................................................. Phone No:.... .�.......................- ----.......�.................
Facility Contact: ...... .... r��1✓ .............. Title: Phone No .
Mailing Address: ..... L;..../=�i.. .._ l`rislet!......�...f Y G -(........................................ ..........................
' .... ...........
Onsite Representative:.... ... (/„ Integrator:....... ,,,�............................................ I.......................
Certified Operator:......jam- .....�., „ Operator Certification Number: ..........................................
Location of Farm:
.................................................................................................................................................----...............................................................:........ t
Latitude • �� Longitude • �� ���
Design Current Design Current. Design _ Currrent
Swine ' . Capacity Population Poultry_ . Ca acity . Po - ulation Cattle Ca acity :Population :r
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Z74 /Z %p ❑Non -Layer ❑ Non -Dairy
_ ❑ Farrow to Wean
❑ Farrow to Feeder ❑Other -
=_' ❑ Farrow to Finish = Total Design Capacity
❑ Gilts
❑ Boars :.r... ;: :. Total SSLW
Discharges & Stream Impacts
Is any discharge observed from any part of the operation?
Discharge originated at: [I 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?
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
❑ Yes PrNo
❑ Yes )RNo
❑ Yes E�_No
❑ Yes kNo
❑ Yes gNo
❑ Yes KNo
❑ Yes PrNo
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
�/
Freeboard (inches). .......... � ................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes [�CNo
Continued on back

Facility Number: Id' — Date of Inspection
6. Arc 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?
I L Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type A';se - /' , -57 . /"i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigatio freeboar , waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
vioiatidtis-oe. deficiencies were'n ed during this visit: Y:oft will•recON46 iid fuf ftf
curies orideixce a'bf this :visit: ' : :. _
5minents7(refer to`questeon #) ,.Explain any"Y
se+drawings offaciltty to better, -;explain sittiatil
❑ Yes 'KNo
Xyes ❑ No
❑Yes KNo
❑ Yes No
❑ Yes XNo
❑ Yes XTo
❑ Yes No
❑ Yes 4No
❑ Yes ;KNo
❑ Yes )(No
❑ Yes kNO
❑ Yes t�fNo
❑ Yes XNo
'KYe
❑ Yes No
ElYes o
❑ Yes �No
❑ Yes o
❑ Yes No
❑ Yes X No
7 '/fry �6�'� /f/i�1�d ,q/fAf�c�CJ�i�COCi.� �.,ifi�osla.�.
AL
�/ : /�`h
Reviewer/Inspector Name -,
Reviewer/Inspector Signature: �. /! Date:

Facility Number: ]p' — Date o€ ln-spection 13 2:�M
Odor issues X
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? []Yes )ia'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'KNo
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes `FJNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes I!flqo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ YesANo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
tiona ornments.an or rawrngs: ,,, �- - u - * i.... 1 - -
AL

State of North Carolina
Department of Environment and Natural Resources REC E!V-D
Division of Water Quality
F E .9 1 5 2000
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
SANDY EVANS
SANDY EVANS 19-20
1305 MARIETTA ROAD
FAIRMONT NC 28340
Dear Sandy Evans:
FAYETTEvILLE
REG. CFFICE
February 14, 2000
A44
0 •2
VAgONOMMENSONM If
-NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No. AWS780045
Additional Information Request
Sandy Evans19-20
Animal Waste Operation
Robeson County
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject application. Additional
information is required before we can continue our review. Please address the following by March 15, 2000:
Best Management Practices (BMPs) that are to be implemented at this facility should be identified (check
the appropriate BMPs) on the Insect Control Checklist and on the Odor Control Checklist (enclosed). The
checklists that were submitted were blank.
Please note that all WUP revisions must be signed and dated by both the owner and the technical specialist Please
reference the subject permit application number when providing the requested information- All information should be signed,
sealed, and submitted in duplicate to my attention at the address below- The information requested by this letter must be
submitted on or before March 15, 2000 or the Division will return your application as incomplete in accordance with 15A
N-C.A.C. 2H .0200 and your facility will be considered to be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid permit is a violation of North
Carolina General Statute 143-215.1 and will subject you to the enforcement authority of the Environmental Management
Commission.
If you have any questions regarding this request. please call me at [phone], extension 364.
Sincerely,
S
Dianne Thomas
Soil Scientist
Non -Discharge Permitting Unit
cc: Fayetteville Regional Office, Water Quality
Permit File
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ .10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Sandy Evans
Sandy Evans 19-20
1305 Marietta Road
Fairmont NC 28340
Dear Sandy Evans:
f
NC-DENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999 R EC H E D
i ,� �i 5 2000
FAYET i EVUE
REG. OFFICE
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 78A5
Robeson County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping.forms (i.e. 1RR1, IRR2, DRY1, DRY2, DRYS, SLUR1, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincere]
X/7��
Kerr T. Stevens, Director
Division of Water Quality
cc: Fayetteville Regional Office
Robeson County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

Type of Visit: QMompll ce inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: routine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
7
Date of Visit: ---/ Arrival Time: p 10 1 Departure Time: ;.J b County:
Farm Name: Owner Email:
Owner Name: _ < d:547 Jy -- }�— L/C 0 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: L�� h „ram � Ila-t?f Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /-t- %--
Certification Number: /��e
Certification Number:
Longitude:
Swine
Design
Capacity
Current
Fap.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
Wean to Feeder
I jNon-Layer
Dairy Calf
Dairy Heifer
Feeder to Finish p
D , P,oul
Design
Ca aci
Current
P,a
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Qther_„�
7 „
Pullets
Beef Brood Cow
Turkeys
Turke Poults
Other
Other
Discharges and Stream lmpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
0 NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/201 S Continued

Facility Number: - Date of ins ection:
/
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ea 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
[E�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
R No
D NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CR 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
QNo
D NA
❑ NE
maintenance or improvement?
Waste Anylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ 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 Type(s): Y � Z ®U tr S n=2 Sy �� rrr Y /- . L�' h�
13. Soil Type(s): /NV I
I4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes allo [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E�No
❑ 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? D Yes [allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [3-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [S No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes p� 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)
3 I . 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 SNo ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes EINo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes 0 No
❑ Yes ® No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
Comments (refer _to .question,#) Efcpl`ain'r-any, YES answersland/or any-additional'recommendahons or.,�any other com nts. " 1
Use drawmgs,o.facility to better _eaplainsituata s-{use:addrtional.pages as n.ec'ry,
Reviewer/Inspector Name: __5 rr _ C
01
Reviewer/Inspector Signature: _
Page 3 of 3
Phone: 1/b�����
Date:
21412015

Type of Visit: QDTompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'Dc7 Departure Time: !� County: Region:l�
Farm Name: Sj3.vtr1 /1� K j �j — Owner Email:Owner Name: Name: r 5Z2.oi V Phone:
Mailing Address:
Physical Address:
Facility Contact: G,` ✓t p��r/��+s Title: Ali(/l7,Pr/ Phone:
Onsite Representative: j Integrator:
Certified Operator: 5,,z,,4 Certification Number: / 7 kl;7_
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity P,op.
Wet Poultry
Design
Cyvaci
Current
Design
MGapacity
DairyCow
Curreut
Pop.
Wean to Finish
La er
-
Wean to Feeder
Non -La er
Da' Calf
feeder to Finish
/ 0
De sign Current
D . P,o_uI -apaei P.o
DairyHeifer
Caw
Non -Dairy
Beef Stocker
M
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Boars
Other
Other
Non -Layers
Pullets
Turkeys —
Turkey Pouets
Other
Beef Feeder
Beef Brood Cow
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 allo [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No [_]NA ❑ NE
[-]Yes [:]No
[] Yes jo No
❑ Yes 5�-No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3
21412014 Continned

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [allo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZJ 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
.171-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
EjNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JE No
❑ 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/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _!� l eyv��fz�zr� ✓�tct ir.� rt-✓
13. Soil Type(s): G(J�.��� / s,Ja1-7o/1-C,
14. Do the receiving crops�iffer from those designated in the CAW -MP?
❑ Yes
Cjj.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ELNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F-A No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
D Yes
2, No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
12gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E�allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JD -No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements [—]Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard I�aste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vq--No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E�-No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Wacility Number: zz-I Date of Inspection: G
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes J,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR 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 fast 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)
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
E] No
❑ NA
❑ NE
❑ Yes
®, No
❑ NA
❑ NE
❑ Yes
rNo
❑ NA
❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [5No
❑ Yes R(No
[:]Yes R No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer.to question #): Explain any YES answers and/or any additions1 recommendations or any other comments.�! %- _ .
Use drawings of facility to better explain situations (use additional..pages as necessary).
'Pal� r
/©�r'�r�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
y��
Phone: 0z
Date: /G —4l
21412014

ivision of Water Resources
Facility Number ®- 1� Division of Soil and Water Conservation
•Q Other Agency
Type of Visit: ompliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 04coutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: G /S Arrival Time: Departure Time: ;/S" County: s�—
Farm Name: Owner Email:
Owner Name: s�,, �da•� Phone:
Mailing Address:
Physical Address:
Facility Contact: .4;_,,,_yTitle: QLu n Phone:
Onsite Representative:
Certified Operator: f �/
Back-up Operator:
Location of Farm:
Latitude:
Integrator: 7
Region: j::1_0
Certification Number: /ZL%__�
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine Capacity Pop. Wet Poultry ., Capacity : 'Pop.
Cattle Capacity Pop.
Wean to Finish La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
eeder to Finish
7
— D —
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , Pou! ' Ca .a Pbo
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La era
lBeef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
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:
❑ Yes E3,No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ®-No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection: -- G— / b
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®, No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes [3 No ❑ NA 0 NE
❑ Yes ®-No ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes
[E� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
CE3No
❑ NA
❑ NE
Comments.(refer-to question #): Explain any:YES answers and/or any additional reeommendations:or,any .other comments:.
Use drawings of.facility to better explain situations (use additional pages as necessary):
old lyou3Ti) Trz U—'t-
Reviewer/Inspector Name: ��c/�_ [_�!�j/v-- Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

[Facility Number: - 157: jDate of Inspection: to —
j Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®, No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZkNo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[MVo
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gLNo
❑ 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)- '4rn1 a
13. Soil Type(s):�yr�-,-�� Npr
14. Do the receiving crops differ from those designated in the CAWMP?
l5. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No
❑ Yes E!�No
❑ Yes [!.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes [ o ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes ff No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes CB -No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [�-No
❑ Waste Application ❑ Weekly Freeboard ❑ 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 EHkNo
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? E] Yes C2FN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
Page 2 of 3 21412011 Continued

Type of Visit: �Z Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: '1 { Arrival Time: t7$ral,D Departure Time:County: 66 Region: FIC6
Farm Name: L L Vrut,_$ f' I D "(�J� Ow``ner Email:
TT
Owner Name: �2� K-5 Phone:
T
Mailing Address:
Physical Address:
� ,� 1�
Facility Contact: '^� (j 0( _Title: Phone:
Onsite Representative: t ( Integrator: i I`16
Certified Operator: bx-4 Certification Number:
Sack -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-
Desi n Current
Desi Current - �� t Des' C►urren
Swine
Capacity Pops' Wet+Poultry
Capactty Pop
Catkle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish
s -
-
Da' Heifer
Farrow to Wean
_
urrent
DesiMits',
D Cow
harrow to Feeder
s,
D, Poult.
ry
Ca a ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes M-Pa ❑ NA ❑ NE
[:]Yes ❑ No [!jKA ❑ NE
❑ Yes [] No (ENA ❑ NE
[:]Yes ❑ No EJ�NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Q2 Vi jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes [:]No [3-WA ❑ 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 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 ff 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
Ej 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
ff] No
❑ NA
r] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(. -No
[DNA
❑ NE
maintenance or improvement? i
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[ o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): �, ,, CjYa`9S S & C) tu
13. Soil Type(s): �� GL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L, Iqu
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E340
❑ NA
❑ NE
1 S. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gErNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
[] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
ETNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZI-No
❑ NA
[3 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
d1rNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

PFf
Facility Number: - Date of Inspection: 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes LIKo ❑ 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:
0 Yes U�No ❑ NA ❑ NE
[:]Yes 03"No ❑ NA ❑ NE
❑ Yes 63 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 021 o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes To ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

Type of visit: ('Doe6m—pliance 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 0 Denied Access
Date of Visit: &.- ,31 Arrival Time:j 5�20= Departure Time: I j,'VdPFT`County: Region: CLD
Farm Name: S ,may / C?-- OZD Owner Email:
Owner Name: sszx•�cy' �/� Phone:
Mailing Address:
Physical Address:
Facility Contact: _ �dy,� S f �;,yr�� Title: el_*� Phone:
Onsite Representative�L. f�yr�� �1/l�-�� Integrator:
Certified Operator: �a,,,� f/ems Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
S.
Wean to Finish Ri7ayer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish ]
h.. Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D .Pout Ca aci. P,o . Non -Dairy
Farrow to Finish
La ers Beef Stocker
Layers Beef Feeder
Gilts
Boars
Pullets
Turkeys
Beef Brood Cow
-
Qther
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E] No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: D---
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
❑ No
❑ NA
❑ NE
r 1
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): a,_ ; P___
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
� Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
JZ 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?
CM Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
M Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RINo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No
❑ NA
❑ NE
maintenance 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): pc/sue
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes INo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes " No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA 0 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:)Yes ANo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [MNo ❑ NA ❑ NE
❑ Yes na No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, 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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3
21412011 Continued

Facility Number: I Date of Inspection:
r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? []Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ®' No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes � No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes fKj No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes SNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes W_No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [, No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E4No ❑ 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),
-by eY
S ,1,f
7, f!' ow IT P`," blt_fA TO T� e Ta r p 00w
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.� zv E1r�
7-0 a v c a LD r v �4-1 r. o� 0,,,- T h >! ba S+ a
s pa) rY�) 4y- s"'-� ��P-�I
G� a a n- �- �t✓�u-� �r � �o�s� �� S�'f'a�'
Reviewer/Inspector Name: ��1]�_ Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit r Routine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number I..-
Date of Visit: 10 7 L Mune: I = 3
O Not erational Q Below Threshold
Permitted OtCertffied 13 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: JEJM2ss -Za County:
Owner Name: - -.. , �...... �Ja..�S Phone No: ,a -- --1 7_- g 8
30 -
Mailing Address...__ l - � - _... ._ .. �" C- ......... 2�9 3 Yo.
Facility Contact: __ "_... ___ Title:._ . _ . _. - _ Phone No: ----- . .
Onsite Representative: �[-----------L•rw+�a _�/ayr►S_ T Integrator. �5_--
Certified Operator._ G Operator Certificajion Number: t�+A Z .. _.
Location of Farm:
ULSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �u -- Longitude �• ��
Swine :. C-aanstaft'_
Current;. :
Cars city Pnnn1aftem' .
Wean to Feeder
Layer
Non-Layer
Feeder to Finish
Z 1-0
SS-07
Farrow to wean
x Other
Farrow to Feeder
Farrow to Finish
y ; Tofid MA
W t
Gilts
Boars
Number m' iagooas ..._..
M�es & Stream Imocts
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?
_z 'De�ga _ Cnnmt
_ .-Catty �-Pnpu�tion
yi Z� �
t> w`SSLRT._
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)
rw
❑ Yes 54No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JRNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other thaw from a discharge? ❑ Yes IQ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes SqNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! LA---- ---- --
Freeboard (inches): 3
12112103 o _I Cont bumd

Facility Number: 8 —
Date of Inspection LO Z2 a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) .
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste ApplicatioWJ2 Freeboar&4D Waste Analyo-*�O Soil Sampli*-**�
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/lnspector fail to discuss reviewfinspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facffities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall/] Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes KNo
❑ Yes WO
❑ Yes 19 No
❑ Yes ;No
❑ Yes ;&No
❑ Yes ,R No
❑ Yes AkNo
❑ Yes R No
❑ Yes J,No
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Facility Number: � — t{S
Date of Inspection s Z
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 maintenancelimprovement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctums lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintemuiceRmprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes J4 No
❑ Yes C5 No
❑ Yes j$No
❑ Yes ® No
❑ Yes No
❑ Yes $3 No
❑ Yes [RNo
12. Crap type ger.wv 5Wl • 4seas K avCse�� Srrs . c, r �4.µ 5 i �aaa_ _ ror,�_5+ue
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes R 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 EI No
16. Is there a lack of adequate waste application equipment? ❑ Yes Wo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below [:]Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes INNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes JRlo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
"JVT- c-, a +OWp-rA V'ej424-4� VW- Cove-r a¢ �•a S �d S
Gtrc7v-►�a+l laetaerv�S .
ReviewerAnspector Name
Reviewer/Inspector Signature:
77/7 1M?
Date: