780063_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental W6

r
it 31�js 7-0,-S-uNF I Gz
M Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 780063 Facility Status: Active
permit AW1780063
[] Denied Access
Inpsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for visit Routine County:
Robeson Region:
Fayetteville
Date of Visit: 0611912018 Entry Time: 11:00 am Exit Time: 11:30 am Incident #
Farm Name: Oxendine Park Farm
Owner Email:
Owner. Curtis L Oxendine
Phone:
910-843-5570
Mailing Address: 151 Mayberry Dr
Shannon NC 283860938
Physical Address: 151 Mayberry Dr
Shannon NC 28386
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude:
34° 46' 49" Longitude:
79' 04' 29"
Farm is on SR 1318. — 1 mile north of SR 1001
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Curtis Oxendine Phone
On -site representative Curtis Oxendine Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
No Hogs in more than 10 years. Lagoon at 48 inches plus. No pumping in 8 years. Keeps rainfall and lagoon level.
page: 1

L
Permit: AVM780063 Owner - Facility : Curtis L Oxendine Facility Number: 780063
Inspection Date: 06/19/18 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Swine
Design Capacity Current promotions
Swine - Farrow to Finish 0 0
Total Design Capacity: 0
Total SSLW
page: 2

w
Permit: AW1780063 Owner - Facility: Curtis L Oxendine Facility Number. 780063
Inspection Date: 06/19/18 Inpsection Type: Compliance inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na Ne
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
i ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (it yes, notify DWQ)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
i ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
■ ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No Na Ne
4. Is storage capacity less than adequate?
❑
®❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
i ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
®❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
N ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
E ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
®❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWI780063 Owner - Facility : Curtis L Oxendine Facility Number: 780063
inspection Date: 06/19/18 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Hay)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Wagram
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
■ ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
■ ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
■ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
1 S. Is there a lack of properly operating waste application equipment?
❑
M ❑
❑
Records and Documents
Yes No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
M ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑
❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
M ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

W
Permit: AW1780063 Owner - Facility : Curtis L Oxendine Facility Number. 780063
Inspection Date: 06/19/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No -No Ne
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1"Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility tail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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 phosphorous loss assessment (PLAT) certification?
❑
■ ❑
❑
Other lssues
Yes
No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
i ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
i ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑
❑
page: 5

al�ls G i-7 �
Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 780063 Facility Status: Acdve Permit: AW1780063 ❑ Denied Access
Inpsection Type: Complianoe Inspection Inactive Or Closed Date:
Reason for Visit: Routine minty: Robeson Region:
Date of Visit- 08/24/2017 Entry Time: 09:30 am Exit Time: 10:15 am Incident a
Farm Name: Oxendine Pork Farm
Owner. Curtis L Oxendine
Mailing Address: 151 Mayberry Dr
Physical Address: 151 Mayberry Dr
Facility Status: Compliant ❑ Not Compliant Integrator.
Location of Farm: Latitude:
Farm is on SIR 1318. w 1 mile north of SR 1001
Question Areas:
Dischrge & Stream Impact Waste Col, Stor, & Treat
Records and Documents Other issues
Owner Email:
Phone:
Shannon NC 283860938
Shannon NC 28386
Fayetteville
910-843-5570
34" 46' 49" Longitude: 79" 04' 29"
0 Waste Application
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Curtis Oxendine Phone
On -site representative Curtis Oxendine Phone
Primary Inspector. Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
No pumping in more that 10 years, no hogs either. Keeps rainfall and Lagoon level, as required. Lagoon at 45 inches or more.
11
) lb -'-*"
page: 1

Permit: AWI780063 Owner - Facility : Curtis L Oxendine Facility Number: 780063
Inspection Date: 08/24/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity Current promotions
Swine
Swine - Farrow to Finish 0 0
Total Design Capacity: 0
Total SSLW:
page: 2

Permit: AWI780063 Owner - Facility : Curtis L Oxendine Facility Number. 780063
Inspection Date: 08/24/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
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)
❑
M ❑
❑
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 Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection, Storage S Treatment
Yes No Na we
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
� ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No tM Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑ 0
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWI780063 Owner - Facility : Curtis L Oxendine Facility Number-, 780063
Inspection Date: 08/24/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes
No Na No
Crop Type 1
coastal Bermuda crass
(Hay)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Wagram
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑ ❑
0
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑ ❑
0
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑
❑ C]
Records and Documents
Yes
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
E ❑
❑
If yes, check the appropriate box below
WLIP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ E ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AW17B0063 Owner - Facility: Curtis L Oxendine Facility Number. 780063
Inspection Date: 08/24/17 Inpsection Type: Compliance Inspection Reason for Visit Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑ ❑
23, If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
M ❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
M ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑ ❑
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?
❑
M ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
■ ❑ ❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
■ ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
M ❑
❑
34, Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

IType of Visit: aCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance J
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access I
Date of Visit: Arrival Time: IGT4 Departure Time: ]!; County: Wa.ScA Region: it0
Farm Name: �.J�Q N O�Ta� FPiit\b
Owner Name: C, swms aXE.N tJ2ty-
Owner Email:
Phone:
Mailing Address: 5 m k OR ,-%M43"tral WC
Physical Address:
Facility Contact: C uR��S_ ('} �Z=t4q Title: ["'j_i0t-,, P t _ Phone:
Onsite Representative:
Certified Operator: Cof"345 1__1 CrIMrDg_
Back-up Operator:
Integrator: AAA
Certification Number: 11KCDy-'
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current Design Current: ''.
Capacity Pop. Wet Poultry Capacrty E�op, Cattle
Design Current
Capacity Pop.
Wean to Finish
11
La er
I
Dairy Cow
Wean to Feeder
Feeder to Finish
INon-Layer I
"' ` .
Design
D . P,oul Ca aei I'o ,
! La ers
Dairy Calf
Daia Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turke Puults
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 2(No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 1YNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes F2/1YNo
o❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes ❑ NA ❑ NE
of the State other than from a discharge'?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: /a j 12-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2rNo [DNA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []rNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
SpillwayT NO
Designed Freeboard (in): i9_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ 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 [,2No ❑ 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 �To ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [g 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 02"No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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):
5.G. o ,
13. Soil Type(s): %cssltn 'LbRMV SPUN 01 W A44aA+f`t1 , W P�K� V _
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 [R(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 2"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[E(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[9'*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 D2rNo
❑ 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 [�fNo
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
VNA ❑ NE
Page 2 of 3 21412011 Continued

i
Facility Number: "1$ - 5.26 jDate of Inspection: /0 IS i `I
24• Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [TNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3No [] 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 [�rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [Z"'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?
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 E3*"No ❑ NA ❑ NE
❑ Yes E9/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes [:]No ❑ NA ❑ NE
33. Did the Reviewer/Inspector faii to discuss review/inspection with an on -site representative? ❑ Yes E5"No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
F
omments (refer to .question #): Ex lain any,YES answers :and/or any additional recommendations or any: other cornments:a n
se drawings of facility to better explain situations (use additional pages as necessary).
�r !•lave �r�cr h�v �.055 �sr.F, � a� o
pF L a�ocr t4p_e 45 Ao b€- CvT wES�
C0c.N(k0\ ztV 41r� tkQf-r�J� ao\!>.
Vaw) 5 i-Aokksoap 'VotLr�s-
N A4e1 kttop Plwxr•AMV' , fat'-bC'M R" �te�ec�,s os• c�(il .
� zF ls, Pk 0.� b tzc �.� b w c.,lt tsv f F,u 5�� �pxo.t� p► � h Fr1vzQ to �� Cash Ra.��`
o�
'Aq �Lit�V-1 . 3N 'aa�o � �E+n F�O� WILM on
ir4l�s I` _W
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
. -S�nTetnS
Phone: �"-tOl-3 1.t4t51
Date: -)
21412011

I YA s a c -r l L
Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 16 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �c7K
Farm Name: _ C'T`' ��CG�^�Ct �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region.
Facility Contact: �� rt �L""� Title: Phone:
Onsite Representative: t( Integrator: _ /V;T
Certified Operator: t Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current Design Current
Swine ' Capacity Pap.
Wet Ponttry Capacity Pop. Cattle Capacity Pap.
- Wean to Finish
11
I
ILayer Dairy Cow
Wean to Feeder
jNon-Layer I
Dairy Calf
Feeder to Finish
t
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D 09P,o_ul Ca aci Po
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
k- r
keys
Other .: s
Turkey PouIts
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 [rNo ❑ NA ❑ NE
a. Was the conveyance man-made?
C] Yes
❑ No
f�J'NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
OINA
❑ 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
&ZINA .
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2T14o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
% No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
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 6j-N7C ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to, the integrity of any of the structures observed? ❑ Yes [4-Ala' ❑ 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
hlo
❑ 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
{�
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Bllo
❑ 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
[3'5o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ h10
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ea<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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 [ o ❑ 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 EdNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
r] Yes
eNo
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2No
❑ NA
❑ NE
Reuuired 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
C�j'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 F1 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 ;a, No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: ry
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No [J # ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No [AOIZ'` ❑ 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 [f NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes ❑ No [3 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
E2�FA
❑ 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
2-MA
❑ 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
E 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
E IN�A
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
❑ No
[�fNA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
�A
❑ NE
34. Does the facility require a follow-up visit by the same agencyr?
❑ Yes
❑ No
E2rNA
❑ NE
Comments (refer W,4q aestion ft Explain any YES answers�and/or. a"y, additional recoznmendateoas orrany other comments:-
Use drawings o,f facrlity to better explain,situations;:(use. oaai,pages as necessary):
Ala R., ,
k6e,rl (2,
Reviewer/Inspector Name: 61 Phone: 43-3— 33;
_ c
Reviewer/Inspector Sig
nature: gnature: �1,� �µ��� _ Date:
Page 3 of 3 21412015

Type of Visit: 07Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access jl
Date of Visit: , . Arrival Time: f� Departure Time: County: &o -F "-r Region: �4
Farm Name: Cend4l aCC lyt'e Owner Email:
Owner Name: [� Phone:
Mailing Address:
Physical Address:
Facility Contact: . (fU! (S 6)X4(x-f Title: Phone:
1
Onsite Representative: i 4 Integrator: E
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
La er
Dairy Cow
Non -La er
DairyCalf
Design Current
D , P,OuI Ca aci Po
Dairy Heifer
Cow
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
r
Turkeys
Turke Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[r" INo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[ A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No
[3-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
r
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[—]Yes
[:]No
C3 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
Ea -No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412014 Continued

r4ft M Em f 4 4
Facilk Number: I V -I Date of Ins ection:
'Waste Collection & Treatment 01
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &Ko❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ZNK- ❑ NE
Structure t 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
ff3-lffo
❑ 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
[ v
❑ 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
[?sib
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
Cg-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
W_bla
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
i�6
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3-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):��',[,t
13. Soil Type(s): ✓�i.K-
14. Do the receiving crops differ from dose designated in the CAWMP?
❑ Yes
�Ie
❑ 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
Q_No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3lo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
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
ED-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 ga'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 [j�<o
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 21412014 Continued

4414
Facili Number: - M jDate of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes E n'o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [ ❑ 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)
❑ Yes
El"No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes ED-K-o ❑ NA ❑ NE
[:]Yes [5-71 o ❑ NA ❑ NE
❑ Yes 2'lgo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. [:]Yes 2-70'o
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [R<o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [10No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2'No
Comments (refer to question ft Explain any YES
Use drawings of facility to hetter explain sRun U6i !
07o yo�s stv� 201r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
i
c
sand/or any additional r
other c
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone: �J33
Date:
2✓412014

` fl l P45
FE14
Type of Visit: IQf Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 6GJ Departure Time: C a✓ County:
Farm Name: AfG� ffnv-r 1Zc✓!�-�_- Owner Email:
Owner Name: _Cick`S 0�C C4,- Phone:
Mailing Address:
Physical Address:
Facility Contact: l _ Cx +�r[5 O jGr 1 cef tA� Title:
Iv �
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
tc
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Region:L
Design_ Giirrent
Design Cui=renti - -= Design Current
Swine Capacity:..." Pop.
Wet Poultry Capacity Pop. - Cattle Capacity Pop.
Wean to Finish
La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
� _ .
Design. Current
DairyHeifer
Farrow to Wean
- .
Dry Cow
Farrow to Feeder
D . P,oui , Ca nci P,,o
Non-Dairy
Farrow to Finish
'Lp
La ers
_
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
+,
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes [-]No &�NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
IOTA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
YNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

c �
Facility Number: 7r - b of Ins ection: i ?- Fafet-"
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Rg-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑1 l�o [DNA ❑ 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 [E 'Ro ❑ 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 El"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? �I'es [:]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? B 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 [D-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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): - 6 ,e Nt°®C_ 4 o ue--S e 41� ``T f t-a- c--
13. Soil Type(s):�py f�IT G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [af o ❑ 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 [ <o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes E No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Q 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 ONo ❑ NA ❑ NE
the appropriate box, r'
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need i provement? If yes, check t appropriate box below ��Yes ❑ No
�rRainfall
aste Application -eekly Freeboard Waste Analysis Soil Analysis❑ Waste Transfers
❑ Stocking ❑ Crop Yield �20 Minute Inspections Monthly and 1 " Rainfall Insp ctions
22. Did the facility fail to install and maintain a rain gauge? Yes VNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑NA ONE
❑ Weather Code
QSSludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection.
24. Did the facility f it to calibrate waste application equipment as required by the permit? ET ees ❑ No ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Ejfes ❑ 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? [ 'es ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [21 o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
To
❑ 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
eNo
❑ 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
El"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
B<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
[�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E31<3
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
2<0
❑ NA
❑ NE
ments (refer to question f : Explain any YES answers and/or any additional recommendations or -any other comments:
drawings of facility to better explain situations (use additional pages as necessary).
q.
7t 0--\
U, W"4
� J
(4a�Q 5 Q Lcu r (
P_X00 C k'eof
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ILVI
Phonifo 13-3 33
Date: 1, X
21412011

s - ,11/7-g/�.i
Type of Visit: O Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O xoutine O Complaint 0 Follow-up O Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: ,QQ Departure Time: .Gad County: � Region:
Farm Name: .'�.r�jo, �ar� lt�iltw' Owner Email:
Owner Name: L.l.Cr`7yS �� Ait,_ Phone:
Mailing Address:
Physical Address:
Facility Contact: C&x45�/,rp, Title:
Onsite Representative: C Z.—k Integrator:
Phone:
Certified Operator: S Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
x.
al Design Current Design C+urrent
Design Current
Swine '
Capacity Pop. Wet Poultry Ca aci Pc Cattle
P tT p•
C•a aci Pa
P h P-
_
_�
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
=
Dairy Heifer
Farrow to Wean
Dry Cow
{ ,a
Design Current
Farrow to Feeder
Il P,oultry Ca aci_ P,o
Non -Dairy
Farrow to Finish
U La ers
Beef Stocker
r
Gilts
on -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
,2.-,.: Turkeys
Othera Turkey Poults
Other Other
Discharges and Stream Impact
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)?
❑ Yes[JIo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
Cr "'r' ❑ NE
BTA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No
[� ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �Ko ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
R<A
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): O
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Na o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
2<0
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
to
❑ 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
to
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3<o
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
G2 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
-Irf
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<0
❑ 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
❑ Yesr�j<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ONo
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
2<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 110
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes [a'1Vo ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ild o ❑ 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 , o ❑ NA ❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No 62-11"A ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ 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 ❑ NEB
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [3'11E
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 to ❑ NA ❑ NE
❑ Yes [ <a ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
0 Yes
K❑ NA ❑ NE
r No ❑ NA ❑ NE
10 ❑NA ❑NE
Use dra`vin2s offaciity to hetter explain sitiiations'.(use additionlifnages as necessarvl. _ any o#her comtnettts � 'I Comments refer- to question Explain an AYES a.ns- ers and/or any.additional recommendationstar
S5- Sl BCE^ r- �.APC
44,e-,
CX
OAF
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: 22 /
Page 3 of 3 U 21412011

10
RUMS _:57'_ o4f`ZD/O
Type of Visit 011rompliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: /n.�'f0 ,w Departure Time: Z % 4�r,.r County: F-� SQL✓ Region: 14900
Farm Name: �?CGNC�irir�_ 817ylk IoEiavA— Owner Email:
Owner NaLe C u r4 Ls t� we fie," G Phone:
Mailing Address:
Physical Address:
Facility Contact: ke 1, cu"- 5 Title: ���''V Phone No:
Unsite Representative: Integrator:
y v d!%eeA$ d. e. VZ_
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑' ❑ Longitude: ❑ ° =1 I ❑ u
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
/Z D
Dry Poultry
❑ La ers
❑Non ers
El Dry Cow
❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
El Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
❑ Pulletiss
❑ Turkeys
❑ Beef Brood Cowl
O#her
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharees & 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 LR'No ❑ NA ❑ NE
❑ Yes
❑ No DIVA
❑ NE
❑ Yes
❑ No 9'lgA
❑ NE
❑ No 0449-
❑ NE
❑ Yes
❑Yes
Ea4?6—❑NA
❑NE
❑ Yes
Elllro ❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: 7 — (o Date of Inspection
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes G o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes To ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
q
Observed Freeboard (in):
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
❑ Yes
ffNo ❑ 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
ISNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]YesEL1'No
Ko ❑ 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
2 No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
ErNo ❑ NA
❑ NE
maintenance/improvement?
t. Is there evidence of incorrect application? If yes, check the appropriate box below.
El3 Yes
o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑} Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) AE'Iirt� G�^ e�o`�tJ� C D. 5,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
0<0❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
B-T o" ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
NoN[I NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElE Yes
,3
I o❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Ej<o—❑ NA
❑ NE
Commen_ is (fe to question #): Explain any YE5`answ andltir any r ommendatton or any other comments';
Use drawn sYot facili to better ex lain stt g ty p uahans: (use" additional pages as�necessarv),
Reviewer/inspector Name kPhone: 9/o. 133. 33aa
'=
Reviewer/Inspector Signature: Date: Z0/ O
Page 2 of 3 12128104 Continued

f Facility Number: -78 — ,3 Date of Inspection
Re uired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes iTNo ❑ 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. ❑ B 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
RKo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,0,,,1
9<o ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElE Yes
o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ala
Q-No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�
EKo ❑ 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
,�,
0<0 ❑ 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
El Yes
,��
L7 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
L3 off❑ NA
- ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0110- ❑ NA
❑ NE
.:.... Additional dy`'�'"r
Gnr�tments and/or rawm g.s D,��,, �. o �
Page 3 of 3 12128104

13 114S S-- fV - ZC 69
Type of Visit OICommpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit eRoutine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: -/S r7�� Arrival Time: 3.4ti7 ,.— Departure Time: 3.�y5County:p SIN Region: I'
Farm Name: 0X N _rAs Poi-K Far''`" Owner Email:
Owner Name: Cur-+iS 09ejeti,re- Phone:
Mailing Address:
Physical Address:
Facility Contact: C+�r"�' S Kziud Title: ri w
C d
Onsite Representative: to 5 L/1eti' "^t e, Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = = Longitude: 0 ° = 6 = «
i
Design
n CurrenttCapacity Population Wet Poultry ty Population Cattle Capacity Population
Current F-apaci
❑ Wean to Finish
❑ Laver
❑ Da' Cow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
IN Farrow to Finish
Z
❑ La ers
❑ Beef Stocker
❑Non -La ers
❑ Gilts
❑ Boars
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
Number of Structures:
❑ TurkeyPoults
❑ 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?
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`?
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes ❑ No MINA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No LJ NA ❑ NE
El Yes ONo [I NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
12128104 Continued

Facility Number: -7 $- (0 3
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No
❑ Yes No
Structure 5
El NA El NE
El NA El NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑< ❑ 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? El Yes (2 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E 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 2'<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes BIZ_ ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Brvo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 13zrtu w_J Aa y
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E� No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
❑ NA
El NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,L7
I�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
,3
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
ReviewerA nspector Name K i2e.ve-1.S Phone:
Reviewer/Inspector Signature: Z—e-P, Date: -/S- 2dc79
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspectionss O Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes L'_TNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LTNo ❑ NA ❑ NE
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
❑ Yes
to�❑ NA
El NE
ElYes
L�'No ❑ NA
❑ NE
❑ Yes
fo ❑ NA
❑ NE
❑ Yes
9`No ❑ NA
❑ NE
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
U0 ❑ NA
❑ NE
❑ Yes
D14o ❑ NA
❑ NE
❑ Yes
B< ❑ NA
❑ NE
❑ Yes
ErNo ❑ NA
❑ NE
❑ Yes
ffNo ❑ NA
❑ NE
❑ Yes
ETNo ❑ NA
❑ NE
Page 3 of 3 12128104

SL%Z,S '7 - 03 -G' 6
Or -Division of Water Quality
Facility Number L7 8 (;� 3 0 Division of Soil and Water Conservation
Other Agency
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: Arrival Time: Departure Time: County:
Farm Name: D)e ear d 7N L Po r't< t0. yr A Owner Email:
Owner Name: Cur�,s Phone: _
Mailing Address:
Physical Address:
%e J6, ,sc "/
Region: F/2-0
Facility Contact: CLy-+, S QkeAf cf l'W C_ Title: �wN �� Phone No:
Onsite Representative: Integrator:-�^'dC4 e1v.4
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = ' ❑ `I Longitude: = ° = ` F7"
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish Z
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er I T:��
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O No ❑ NA ❑ NE
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
DrNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes
�ENo
f No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: -j — .3
Date of Inspection f� D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E31�o
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L fNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Eal�o
❑ 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
L'J 1No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
[10
❑ 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
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
O'15ro
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) K d ;._ /-/ - SSG 4/ 6,-q •;./ r!0 (/ wSc
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
oo
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,L—'J,
[?. Now
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
llo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
l_a'1No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name `ck 2 e(S Phone: 110, f'
Reviewer/Inspector Signature: Date: D
12128104 Continued

Facility Number: % S — 63 Date of Inspection d / -
Reguired Records & Documents
Did the facility fail to have Certificate of Coverage & Permit readily available?
El[ Yes
--,,!!
o
ElEl19.
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,3
CI No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D 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
�❑
I_I No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 01 o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0,1�o
❑ 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?
El Yes
,[-3,.<o
Is No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2-i o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
��
L7 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B*14o
❑ 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
,—,�
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2<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?
❑ Yes
C3'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
©
❑ NA
❑ NE
Additional Comments and/or Drawings: I
12128104

RIQ OM&e j- 6 -I9-zoo 7
® Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- e) Other Agency
Type of Visit ID Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: to -1 g- b Arrival 'Time: ; 3a M Departure Time: 3:.3o County: R °� �p"� Region: G'eo
Farm Name: Q,i g jcl,'At c,_ A rk _ rrvr Owner Email:
Owner Name u ors L ec'�je723 - Z& 0-3Phone:
Mailing Address:
Physical Address:
Facility Contact: Cur s 0
d� ^` t- Title:
L9 1AJ"e.V—
Phone No:
Onsite Representative: Cut-+i S
O eeoydr N C_
Integrator:
.1�1 dry+^zd 4 N
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I = 11 Longitude: = ° = I =
11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish 'Z ZO
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design "Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: IT];
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 i ] No ❑ NA ❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑NA
[I NE
El Yes
nNo
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[21No
❑ NA
❑ NE
12128104 Continued

Facility Number: 7 Date of Inspection
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes M No ❑ NA ❑ NE
❑ Yes [M No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _44
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 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
[3No
❑ NA [I 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
V] No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[�J No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[X No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Applilcattii'on Outside of Area
�u Pa5'kA t-L)
12. Crop type(s) ,= f V-WLjw_'0.
1
f O u Gr$ eftI J
13. Soi I type(s) p Gct l 1 a L o a w Sarr� , WAQvc LJ aX,& tkcl-
14. Do the receiving crops differ from those designated in the CAWW?
❑ Yes
M No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
yes
[�j No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
q No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[>2 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name Rt L k, Re-v S Phone: 'F/0, y . 333-0
Reviewer/Inspector Signature: F Date: (o — /g — ZO D 7
12128104 Continued

Facility Number: -7 — 6-3 Date of Inspection
1
Required Records & Documents ,,�..�{{
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LG No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2f No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [%No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4i No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[21 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ 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
[0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
n
Date of Visit: 102-2Y-0 Arrivat'Time: A 047 1 Departure Time: County: l,,o6eSoi.!
Farm Name: 0� �wt Owner Email:
Owner Name: nu j- fi3 _ nl�2Na��/ Z Phone:
Mailing Address:
Region: E P-0
Physical Address:
Facility Contact: Cizr}i'S x'e.y4rr/d a ____ Title: 4_96241 f- Phone No: l
Onsite Representative: Integrator: ZV Je ci#_ T
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 0' E=1" Longitude: ❑ ° 0 . ❑ ff
Design Current Design,0407Curent Design Current
5 one Capactty Population R et Poultry Capacity. Population Cattle Capacity Population
❑ Wean to Finish
❑ La er ❑Dai Cow
❑ Wean to Feeder
❑ Non -La ei iry Calf
Feeder to Finish
2 al.: " ❑ Dairy Heifej
❑ Farrow to Wean
t y tr ❑ D Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ La ers El Non -Dairy
❑ Beef Stocker
❑ Non -La ers
❑ Beef Feeder
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other },
❑ Other
❑ Turkey Poults` -
❑ Other Number of Structures:
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?
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 [gNo ❑ NA ❑ NE
❑ Yes
[)O' No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[A No
❑ Yes
0 No
❑ NA
FINE
❑ Yes
[:W'No
❑ NA
❑ NE
12128104 Continued

l
Facility Number: '7 — &3 Date of Inspection Z Zy-C
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): :3 4,
Observed Freeboard (in): 3 9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 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
EffNo
❑ 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
[RNo
❑ 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
[XNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[9 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 ElEvidence of Wind Drift ElApplication Outside of
Area
12. Crop type(s) .6,Z-i, M K c� /Gt ALI slat c. // ag, i
13_ Soil type(s) POB LJK,6 OA.13
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RfNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination"❑
Yes
[X No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[XNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA ❑ NE
Reviewer/Inspector Name �.V e. S ;.. , �+ ::, Phone: iLT" %S
Reviewer/Inspector Signature: IS Date: O�. -L Z o
12/2"4 Continued

Facility Number: — 3 Date of Inspection o2 -2y-C4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
50 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
XNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ 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
[)INo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1� No
❑ NA
❑ NE
Additional C6m' meiits `and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit S Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilitt- Number
Ante of N"isit: // /� o5/ Time: %: a a
_� (e 3�
Not O erational Below Threshold
© Permitted IN Certified 0 Conditionalby Certified 13 Registered Date Last Operated or Above Threshold
Farm Name: _ Q 1C e.y CA i �. e „ Pe, .k• Far m County: -Pj FP-0
Owner Name: C '� s s 6 ]f e_.,cA . % t Phone No: 9 103 — SJ 7d
Mailing Address: �+15, /y 2!jt 1, ter.. 1), ; v e_ _ Q_rirs n � _ /v C lags it 6
Facility Contact: e a cQv., r Title: el Lams` Phone No: s a
Onsite Representative: C Integrator: "r •+ �e,st��e...k
Certified Operator: C., -l-�4 SS L r) d;,n t Operator Certification number: # �� 710A
Location of Farm:
I@Swine ❑ Poultry ❑ Cattle ❑ Horse Latiitude 0' ° 0" Longitude • �• 0 K
Design Current Design Current Design Current
Swine capacity Population Poultry Capacity Population Cattle Ca aeity Po ulation
❑ Wean to Feeder I I I JE1 Laver ❑ Dai
[3Feeder to Finish ❑ Non -Laver ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish J a O Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JJE3LAgoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ Ke Li uid'Waste Management System
Discharges & Stream Impacts
1. Is anv discharge observed from any pan of the operation?
- - El Yes [A No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. if discharge is obsen-ed, was the conveyance man-made? El Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in galimin? /V/Ar
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure ? Structure 3 Structure 4 Structure ; Structure 6
Identifier: AIWO l
Freeboard (inches): if
05/03/0I Continued

Facility Number: f — (�3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [10 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes jZ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ® No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance./improvement? ❑ Yes I(] No
11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes P No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type & J-M k ae'* gnaq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 09No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes R No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ® Yes 12] No
15. Does the receiving crop need improvement? ® Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Usues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Field Copy ❑ Final Notes
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`at 000 iGVGtd., �`iLC 'Q GrO � � � C1a� �' u r ►..�.
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ov4�t �4� �• iy. a~�.f.� Pear`, wr
Reviewer/Laspector Name a --� rife ,µ
_ r
Reviewer/Inspector Signature: Date:
12112103 / Continued

Facility Number: %� — G.3 Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ VW, checklists, design, maps, etc.) ❑ Yes §Q No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IN No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 141 No
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes ® No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application) ❑ Yes ® No
27. Did Reviewer/Inspector fail to discuss reviewimspection with on -site representative? ❑ Yes ® No
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes J%No
3 L If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No violations or defidencies were noted daring this visit. You wiD receive no further correspondence about this visit.
12/l2103

it •
Type of Visit ® Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit ®Routine 0 Complaint (:) Follow up Q Emergency Notification 0 Other ❑ Denied Access
Date of Visit:
/� Eg 0 Time: O D
Facilin' Number
L --
t
Not Operational 0 Below Threshold
� .--.,..
.�� ....ro
10 Permitted 0 Certified
© Conditionally Certified
0 Registered
Date Last Operated or Above Threshold:
Farm Name:
P
rti
County: (2, abexdyN
Owner Name: !L:UjAi'C
Oxe..-,-di
Phone No: _ �1 0' k43
MailinrAddress. _ i91
rAe. �Gfei4
Facility Contact:
Ct_d;S 0 tce .,d-�Ic_
Title: xj
_ Phone No:
_
Onsite Representative:
e < e.�r
�':..`
Integrator:
Certified Operator:
Lt�r�, S Q'i c,^A.
r.a
Operator Certification Number: Is �a 1
Location of Farm:
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° i. longitude ' �• � -
Design Current
Design Current Design Current
Swine Ca achy Population
Poultry
Capacity Population Cattle Ca achy Population
❑ Wean to Feeder
10 Laver
I
I
❑ Dairy
❑ Feeder to Finish
IEJ Non -Laver
I j
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
® Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons I 1 I ILI Subsurface Drains Present
Holding Ponds / Solid Traps ❑ No Liquid Waste Managen
Discharges B Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Svrav Field ❑ Other
a. If discharge is observed, was the conveyance mar -made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observ-ed, what is the estimated flow in sal/Min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area Spray Field -Area
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? ❑ SpiIlway
Structure I Structure ? Structure 3 Structure 4 Structure
Identifier:
Freeboard (inches): at L
0510.3101
❑ Yes ?� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes W No
❑ Yes ® No
❑ Yes N No
Structure 5
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes [ANo
❑ Yes W No
❑ Yes [A No
❑ Yes [,No
❑ Yes [� 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 ❑ No
12. Crop type -„ 0, S Az
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes gNo
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
[5,No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
IRI No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes]
No
(ie/ discharge, freeboard problems, over application)
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
W�No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
i
:'tF �}ti as�l+Y,.. .: '14Ati u; -. �-Ybw..._--s,uSxb' um. ,.. YUIU HN.;.S' .PAC,'.. _. !D!Final
(refer to;yueshon #) Explatn,any YES suswers':andlorany recommendatrot}s or any,other commeirawrngs
facilitpto
of better explain sitpattons;use
Oil-
addrtionaEpages as necessary) ❑ Field Copy Notes
),,f-dA-ments
G o-n r%c wcA- GolO c
C O C SS iACd �L0 ° 3
r
Reviewer/inspector Name
Reviewer/Inspector Signature:
Date: iQ
05103101 v Continued

Facility Number: Date of Inspection
Odor lssiLes
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 bladc(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 pemianent/temporwy cover?
05103101
❑ Yes No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No

Faciliri• Number —Date of Visit: ime: �d
Not O erational 011giowThreshold
Permitted O Certified 0 Conditiioonallly/CertiCfied ©Registered Date Last Operated o Ab%v�e Threshold:
Farm Name: Leh i AL" / dr ^ L a�`h�l Count: lJ
Owner Name: rL_, r 1 S Phone No:
Mailing Address: /;?_.14_�" A)C_ Z 3
Facility Contact: e ' Title: t� Phone No
Onsite Representative: &,rjA_ e� Integrator:eAr�"
Certified Operator: LOperator Certification Number:
Location of Farm:
❑ Swine ❑ iPouttry ❑ Cattle ❑ Horse Latitude 0' 0 0 " Longitude ' 0 0
Design
Cent Design
Current -
D,esEgtt - Correct
y �_ r ..
Swine . Ga achy . Po uiatwn 'Pon ._ achy . "'Po ulaition - ...= Cattle -� _ . Ca actty -: P uiatum ,
❑ Wean to Feeder
- [] La er
D
-
Feeder to Finish
❑ Non Laver
Non -Dairy
O'Farrow to Wean
❑Other
El Farrow to Feeder
--
-
Farrow to Finish L
7. -
TotalDes Capacity
Gilts
❑ soars
-
T.ota1.SSL'W
Number of Lagoons
❑Subsurface Drains
Present ❑ Lagoon Area
❑ SP ray Field Area
�
:. —_
HoNdmg'Pondi ! Solid Traps _ ' ;
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, 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? ❑ SDillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes Z No
❑ Yes No
❑ Yes ] No
❑ Yes
9No
❑ Yes
4No
❑ Yes
A No
❑ Yes
V�No
Structure 6
Continued

Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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?
NI ante Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ex sive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Q� �o— U Ir ee
13. Do the receiving crops differ with those design a in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify- regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes P�No
❑ Yes ZNo
❑ Yes r�(No
❑ Yes
❑ Yes ; NO
❑ Yes �No
El Yes ANo
❑ Yes No
ElYElYes1INo
esNo
El Yes
❑ Yes XNo
❑ Yes 'kNo
❑ Yes I�No
❑ Yes �No
❑ Yes [9No
❑ Yes E�No
❑ Yes R No
❑ Yes ,@ No
❑ Yes o
ElYes No
❑ Yes ONo
No violations or deficiencies were noted during this visit. You wiil receive no further correspondence about this visit.
Gommeats,(referto gtrest:oia #) lExplaut any YES answers az:dlor any t ecotntnendattons ur#anv aiher_comm_ents:
Use drawings of facility to`betttr eicplatn srtisatiaas. fuse ad�ittanat pages ss necessary) e ❑ Field Conv ❑ Final Notes r x
-
- e -u :.
comer
� l
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 2i 7� Z
0510310I
Continued

Facility Number. 7 —631 Date of Inspection 1
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 10
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 N0
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 XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
05103101

vrsibn of. Water Quahty
Divisian.of Soil and Water:Conservataon r
a (/'
0 ow M er Agency
Type of Visit Acompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: �Printed on: 10/26/2000
Q Not Operational 0 Below Threshold
Permitted © Certified 0 Conditionally Certified 13 Registered Date Last Operated or f ove Threshold: ........................
6 Farm Name: e
X...................
. .....................................O!L...County:.rs�
............�.................
OwnerName:... r [.f........... O..............tl....................................... Phone No:........,P �`'.. .4�.. :7........_....._....................
Facility Contact: ......1�.....�t.e*K.C..�...... . Title: ...................................... .........................
Mailing Address: ... f p �� , �'*7.... Z
Onsite Representative: ...... do.G.j l.'4:. . r....................................................................
Certified_,��,�tL...„.•-
Location of Farm:
Phone No: ....... r` ',
,�.a.. .. %l C Z �3�
....//...................................... .......-.
Integrator:...............,a(,...
Operator Certification Number:.....
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� ���
Design Current
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Farrow to Finish zD Total Design Capacity Z 0
Gilts
❑ Boars Total SSLW
i
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impactx
1. Is any discharge observed from any part of the operation? ❑ Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other KNO
a. II' discharge is observed, was the conveyance ratan -made? []Yes ANo
h. If discharge is observed. did it reach Water of the State'? (if yes, notity DWQ) ❑ Yes KNo
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes JNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes $No
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
,
Structure I Structure 2 Structure Structure 4 Structure 5 Structure 69
Identifier: .............. ...............................................................................................
Freeboard (inches): / .
5100 Continued on back

Facility Number: — Date of Inspection Printed on. 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes kNo
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 �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNO
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Pr
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Wo
Waste Application
10. Are there any buffers that need maintenance/improvement'? ❑ Yes Pio
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Alo
12. Crop type I'Ser
13. Do the receiving crops differ with those designated id the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes RTo
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 JTNo
15. Does the receiving crop need improvement? ❑ Yes *Io
16. Is there a lack of adequate waste application equipment? ❑ Yes 81No
Reauired Records & Documents
17. Fail to have Cenificate of Coverage & General Permit readily available?
❑ Yes
X No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
I�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
r.No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J"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/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
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
9�No
viglations:or d�fciet�ies v►�ere ngted daringhis:visit: Moir willeeeiye Rio fui-thgr
correspondence. atbanif this .visit.
`ominenti (refer to question #) Explam,any YES answers and/or any -recommendations oraw
Jse drawings,of facility tq Better explain situations "{use additional pages as necessary]:..
i ��cel�.
�-r 11__ �� -9 r yin..
g� germ kJcLaigod
-�ie�d •
ter comments
.7
46
T
IReviewer/Inspector Name I
Reviewer/Inspector Signature: Date: -7—e'-3—0,1 s/o0

w
•I Facility Number: — 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
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?
tiaa ommeats An ar. ra
tr
❑ Yes
�No
❑ Yes
4NO
❑ Yes
o
❑ Yes
o
❑ Yes
El Yes:rNoo
❑ Yes
J
5100

0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Date of Inspection 4! �e
Time of Inspection ;v'a 24 hr. (hh:mm)
G Permitted 15 Certified 0 Conditionally Certified ❑ Registered 0 Not O erational Date Last Operated:
t �
Farm Name* t;�,R/ .....L/.k:e •✓�'�r�� �A.Cs-�-......................... County: _..... .45�....................... .................. I--__
Owner Name: .......... �1. Az!f .....---i�........................................ Phone No:.. �� _..2.. r. ..- .�� Q..___...........
FacilityContact: .....CP c l.-:-�........ ..... Title: .......................... . ........... . ....................... Phone No: ............... .......... ......... __... _.......
Mailing Address: ........... .1.. .... � �... U1Q/v �.. !9N..!!ao.✓f..'Al.c..... .. .......................................... ....... .....
Onsite Representative: ................................ Integrator:.---.........
............................................/ ... ...............
Certified Operator:.......�j{s 7 5. :........ ,�✓d/s! ....................... Operator Certification Number:.................
Location of Farm:
................. ............................... ................................................................................................. ................................................... ................................ ........ A.
.... ....................... ...................................... ....... ._............_._...._._.
Latitude 0 t 64 Longitude ' d 44
-•Current Design,,
Ca achy = Po illation .Poultry, Capacity;::
Swine
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
ElFarrow to Feeder
Farrow to Finish
-ZO
Z D
Gilts
❑ Boars
Nn�ber of..Lagooris '
Cattle
_ ILJ Non -Layer IL1 Iron-isairy I I i
• ; Other 4 s
OR sig Den Capacity€
�.. T Total' SSLW
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Waste stem �, . _ 7-7
No Liquid Management S �r
_ ❑ 4 g Y
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon [ISpray 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? ElSpillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .................. ......... .......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes KNo
❑ Yes IgNo
❑ Yes U No
❑ Yes KI No
❑ Yes 91 No
❑ Yes 9No
❑ Yes E$ No
Structure 6
[:]Yes jo No
Continued on back
3/23/99

Facility Number: 7S, — Date of Inspection
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 Aoulication
❑ Yes We
❑ Yes t'No
❑ Yes No
❑ Yes tRNo
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
i o
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN
❑ Yes
We
12.
Crop type 6 lf-111 r
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
El 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
RNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 No
Required Records & Documents
17.. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes A No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WiJP, checklists, design, maps, etc.) ❑
Yes ) No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes XNo
20_ Is facility not in compliance with any applicable setback criteria in effect at the time.of design? ❑ Yes 0No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes J9 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 reviewfinspection with on -site representative? ❑ Yes JQ No
24. Does facility require a follow-up visit by same agency? ❑ Yes rIffNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No
yiQla�iQns o dgfciei�c�e orrre pAduring his;v siti You wi�i tei ipe i#q futtM
.i ::..g.r
..e:bois vs.......resnndencutth:
IReviewer/Inspector Namev R
Reviewer/Inspector Signature: ,,� Date: G �d r2Gt7Y,

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 actor below ❑ Yes [A 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 �WNo
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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes H No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ff No

/,
t
Division of Soil and Water'Consei vation�peration Rei�ew _
= -
D.Dryiision of Soil andWa#er.Conservakron CompLance.T■_ econ 3 7.
a
x'yD1vi!4On Of Waterh#y ;COYnpllanCC Inspect�On r * r pi
- x
t , z Other Agency Opecaaon Review _r -
s
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-uE of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh.mm)
0 Permitted Wertified E3 Conditionally Certified © Registered d
� 13 Not OperationalOperationad Date Last Operated;, ,,,,,,,,,,,,,,,,,,,,,,,,,,
f �$��
Farm Name: ....Qs�e r..! .�:..... P40 r{ ....... rsY1,.............................. County:........W.f ....................-........-..........................
Owner Name:..... L.! S....................... ...... oxn �'!........................ Phone No: .... oz� _1...e��..: S d... ................
Facility Contact: ..........0. 1 ....................................... Title:................... hone No:......: "
( f .............../...
'Iailin}; Address: ......{...:....,[- �i..............................:............... ..�i Q.�?.!^..a. -.................fl. k7.
f...... ..... �......
Onsite Representative: ....................................................................... Integrator:
r-
......................................................................................
I�
Certified Operator:,.... ...................... ,t..... ....... Operator Certification Number:..........................................
,?C............
Location of Farm:
Latitude 0 6 C7•= Longitude • 6 «
Discharges & Stream )acts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo
Discharge originated at: ElLagoon [ISpray Field ElOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes AA No
NA c. If discharge is observed, what is the estimated flow in gal/min'?
d. Dices discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes XNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes k,No
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):............................................................................................................................................. .............. I-- ..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J�No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — � 1 Date of I11spection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
O�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7- Do any of the structures need maintenance/improvement?
❑ Yes
gNo
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
19 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[VNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ol No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
14,No
12. Crop type &- L 19 u 0.
13. Do the receiving crops differ with those designate 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
ANo
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
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
ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ANo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 19.No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes fit' No
24. Does facility require a follow-up visit by same agency? ❑ Yes MNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9No
*0•Vl61alti6r_is;or• dd* kit r'cies W£re noted- [luring this:vlslt. - Yop 'WJ11-r•eeeive it ufth.�r
corresborid!enke: ahotiti this visit....:..:... • ........................... .
99

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 ❑ Yes XNo
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 XNo
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 F<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 9No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KN 0
tiona ; m _omentg an or rawings �.._.,�;.: ":__ .n _ .
7
3/23/99

f _ - I
❑ Division of Soil and Water Conservation ❑ Other Agency
10 Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection®
Time of Inspection O 24 hr. (hh:mm)
Registered brCerfified 0 Applied for Permit E3 Permitted JE3 Not Operational Date Last Operated:
Farm Name: ........... oxltij'Rc......... rels�...... &w'r..................................... County:....................... ........ .......................
OwnerName: ........ . .. Q6................. .......... a........................---.... Phone No: _!!u.........g .. J�.................................
Facility Contact: ......... \.1., f A�'5............li, XI� 4lk--.. Title:.-• ................ ......... Phone No:
Mailing Address: .......... a...........I......... e.Px.......... .......... ........... S hA 10C. G ...............
.... ............ .
Onsite Representative:..... c4fr1..1.5........... 0X'r't c,(t�................................... Integrator: ...... .........«. epe - .e��....................
I o
Certified Operator. .................. ie.&............... ........ ax.
.&L.4—C ................... Operator Certification Number ........... .!?---
�O. ....................
Location of Farm:
0
'o
Latitude • ` 46
Longitude �• �� �"
t ' Design - CnrrenYh D
im Poultry .;" Capiicityr`Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
o�D
❑ Gilts
❑ Boars
V Layer
�
!�! ua�ry
❑ Non -Layer
❑ Non -Dairy
❑ Other.
w
Total Destgto Capac><ty
u
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes P(No
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? N R
d. Does discharge bypass a lagoon system? (If yes, notify, DWQ) ❑ Yes KNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes XNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes A No
maintenan celimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JZNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P(No
7/25/97

1�
Facility Number: —�
8. Are there lagoons or storage ponds on site which need to be properly closed'?
❑ Yes
XNo
Structures (Lagoons.tloiding Ponds, Flush Pits. ete.M
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure l Structure ? Structure 3 Structure 4 Structure S
Structure 6
Identifier:
Freeboard(tt): ........... ...LI.....................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes,
N0
11, Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
V No
12.. Do any of the structures need maintenance/improvement?
❑ Yes
9 No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application �
14. Is there physical evidence of over application'?
❑ Yes
ANo
(If in excess of WMP, or runoff enterin waters of th State. notify DWQ)
15. Crop
l
type................_............Qr1rLY1 .
16.. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
ElYes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
XNo
18. Does the receiving crop need improvement?
ftoYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
XNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
ANo
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ANo
22. Does record'keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
,
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
❑ Yes
O(No
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
❑ Yes
WNo
25. Were any additional problems noted which cause noncompliance of the Permit"
❑ Yes
❑ No
0 No.vio'lations or deficiencies were' no' te'd-during' this'visit.- You.will re'ceive n' o further
corr606ndence dh..oitt this. visit'.
Coin f66 (cefer'to.question #): Explain an} VES answers and/or any recomnendattons or any other continents.
Use,drawings of facility to better:exptain situaEioas. (use additional pages as..ncces`sarv)_
s
AV- #Vvvn 4ar� kae, - (11�11 JK
R�, V
(XV C6 4jx4m avA" J?V�- (�V,
0�-
If. ALJ s' arjulo If e 44 L LVVI 4 070 14- �7 45P 4 � . 1 0 1 J A - � S�' � � �_ a. +�3'1/vt/� #_f5N'rAlt
Reviewer/Inspector Name
►.iFT rl
tA .
ReviewerAnspector Signature: Date: (9 a4,—

� 1e
pivision of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine O Complaint O Follow-up of DW2 'tns ection p Follow-up of DS%VC review Q Other
Date of Inspection —
Facility i\'umber
Time of Inspection 24 hr. (hh:mm)
Registered E3 Certified © Applied for Permit U Permitted 113 Not Operational Date Last Operated :..........................
....................................
Farm Name:.... tGt D u,� County:...... 6 lfK.-....................................I............
e
rs 7 0
OwnerDame:.. .l-t...... .1. .......................... X "�1..`-'i.!�1.. ........................... . ............................. Phone No:............_ ..................... I.................
Facility Contact: k.. t...... pLC!r..� ...... Title: `�' e r........................
n1..... rr� p CC............................................................ Phonnne No:..,
Mailing Address:...:./.�.-.I:. �...1. B.. � �-�l. ' C .i_G •• ►�..4..r-. PLC..................................
................... .40q(o,.....
Onsite Representative:.... �`..`....:`.e....................................................... .. Integrator:......................................................................................
Certified Operator—.�.! ri0......................... 69X. - .A.C....................... Operator Certification Number ...........................................
Location of Farm:
Latitude Longitude
>> - Design Current' Design Current Zr;gesigrtCnrreit
A
Svt?ine ;°Capacity Pvpplation Poultry Capacity Pnpulatron Cattle � Ca acrty PopWatian :
❑ Wean to Feeder
.
❑ Layer I ❑ Dairy
" ❑ Feeder to Finish
.. ID Non Layer 10Non Daisy M
v ❑ Farrow to Wean
Farrow to Feeder '� {�
o-ti ❑ Other s
Farrow to Finish
x '
Total Destgn Capacity Z E)
• ❑ Gilts
r �=
❑Boars
= yTatal`SSLW E
Number of Lagoons/Holding Ponds y© � ❑ Subsurface Drains Present Lagoon Area Spray Field Area
0elee
h o Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Surface Water? (If yes. notify DWQ)
c. if discharge is observed, what is the estimated flow in gaUntin?
A. 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
mai n tenance/i mprovement?
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?
7125/97
❑ Yes tNo
o
❑ Yes
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
)6,No
❑ Yes
No
❑ Yes
kNo
❑ Yes No
❑ Yes No
Continued on back

F
M
Facility Number: % —
8. Are there lagoons or storage ponds on site which need to be properly closed? k(Y
es ❑ No
Structures fl.a oons Holdin Ponds Flush Pits etc.
9, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): .................................................................................................................................... ............................ ............................................
10. Is seepage observed from any of the structures? ❑ Yes XNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes gNo
12. Do any of the structures need maintenance/improvement? ❑ Yes gNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff en ring waters of the State, notify DWQ)
15. Crop type _....t?r~vz. k Q
16. Do the receiving crops differ wiO 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 Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.vinlationsor. deficiencies,weren0 ed during this:visit: You:will receive nti further
:. corr6:p4rtdeitce d out-this:visit::.
❑ Yes ANo
❑ Yes ANo
❑ Yes ❑ No
❑ Yes XNo
❑ Yes P No
❑ Yes [&No
❑ Yes Plo
❑ Yes A No
❑ Yes P,No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
.,..� R - t, :. _ s. r - . -- •:s , �r rr�.;.�:as�. ,vim _�n. ; --- tea y �,. :, .,z�-c CC,
Cvmmes:(refer'to question #):Egplaru any YE5 answ ers sridloranykrmmendatrons or any other com�tteats: r
P' i,r", -
�z,�
�+�n' � i::�4°.24 gyy yu•alryt. '� GT k."' K. s:��..iiy°°� �.> :•3' � � .-ay.�'�..wPo v,�n. �k ..�u &F�%.A"Y . A�Y�R� -.
Use drawutgs oC facthty�tA bette�r�eupla�n sttuadons (use addttional pxges�as necessary � �� �,� � ga
.
�k
.�"F�
.,�$'��":Y�'ixa�_�.��V.i'tso-3 •.,.xi3 a,•-sw-3'e �asH.ro-''"aik ats,,,.z��&r�, 7�a.# -'-v s"a`
jrlr. 1(e i.AO i5 Lji IvRCS to 5e e C&4,'
i
D(d Ck-'I oorti r,a��J2 Close4 0"+
7/25/97
�
..em�ss
Reviewer/Inspector Name w -
a �.E
Reviewer/Inspector Signature: Date: . ZQ--C/
V
aUf

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Curtis Oxendine
Oxendine Pork Farm
Rt 1 Box 125-C
Shannon NC 28386
SUBJECT: Operator In Charge Designation
Facility: Oxendine Pork Farm
Facility ID#: 78-63
Robeson County
Dear W. Oxendine:
1 • e
IDE�HF;Z
F�Grl
glit? fF0
NOV 19 1996
ENV. MANAGIEME tT
FAYETTEVIL E REG. OFFICE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919n33-0026.
Sincerely,
1 4
1
A. Preston Howard, Jr., P.E., D ector
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 27687,.
Raleigh, North Carolina 27611-7687 ���� r
An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/look post -consumer paper

.;
Division of Environmental Management -78 -63
Animal Feedlot Operations Site Visitation Record
Date: 5 4
Time. ,00
General Information:
Farm Name:
Owner Name: C. Ai c nic—e4 6y, _ _ _Yhhone No:
On Site Representative:_ M r • _�,ee�. ,�fl— —Integrator. A&
Mailing Address:_ -_ 1 Lax 1a-5- G -- .
Physical Addressfl ocadon: O,U 149- as r- Est Gps� ��.-� 13 � .8 4 00 {
Latitude: / Lon 'tude- I /
Qneration Desci iplign. (based on design characteristics)
ow
Tj+pe No. Animals Type of Poaltry No. of Animals Type of Cattle No. of Animals
�► _ I OD 0 Laya 0 Dairy
0 Nmsery 0 Non-U3= D Baef
O Feeder
OtherType of Livestock Number of Animals -
Number of Lagoons: (include in the Drawings and Observations the freeboard of each lagoon)
Faciffigy ns ec ' ,
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
0 Mae -made 0 Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop nerd improvement?:
(lisr the crops Whi need improvwuW)
Crop type: Acreage: %
Setback Criteria
Is a dwelling located within 200 feet of waste application?
"Ls a well located within 100 feet of waste application?
Is animal waste stockpiled.within 100 feet of USGS Blue Line Stream?
-Is animal waste land applied or spray irrigated within 25 feet of Blue Line Strum?
Yes 0 Now
Yes 0 No 13
Yes 0 No M
Yes ❑ No f.%
7 "
Y 0 No0
Yes 0 . No SF
YesI1 -No 0 .
- Yes W .No 0
Yes 0 NoIW
Yes 0 NoEb
AOI — Januaq 17JM

Maintenance 43 '
• Dorn the facility maintenance need improvement? Yes O NIAW
Is there evidence of past discharge from any part of the operation? Yes 0 No 14
Does record keeping need improvement? Yes 0 NO O
Did the facility fail to have a copy of the Animal Waste Management Pisa on site? Yes O No Cl
Explain any Yes answers; J-tvo-k Lv-jc.a = _ 6e*2�h, eg�: j6 his.
signature: Date•
c= Fac fry Asse=ww Unft Use Anadownts ¢Needed
Drawipgl or Observations:
�'vlr�a.J `+t Wb r �i.r, • s� r��y p �iLr� �.
It Ff
Lf 4CS r V
AOI -- Janes 17,19%
_ _ •'...�/..�/»w►. mesas. s•. ��a- �_L• I�`f/s��•p.wteai7�r-e±Rr.+vw+..r r'�f-::.
- r/�•. :i_ti 1•w��' ..��a'r•*! a� �,e.S /�:f 1tr•�i�.. �. JF��a.t/�... �� r -.

Site Requires Immediate Attention: Z
Facility No. D S G 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Cyr 13 , 1995
Time: 3 : O 0 t
'Farm Name/Owner:
'Mailing Address:--,-
County:—
Integrator: ' Phone: NR
On Site Representative: Phone: q ` o l EIA 3 _ - SS -1 a __
Physical Address/Location: L _ -A �,r;.� G _ +., d� C r, , � _,R d _�A l 3 k a � a
r�y> li7e-ST ­;. A e, o—C kw" � � -- �,*- A'
Type of Operation: Swine -_)� Poultfy Cattle
Design Capacity: s,,s Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude:
Circle Yes or No
Does the Animal Waste Lagoon hhave sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No ActFreeboard: i-V _ Ft. Inches
Was any seepage oby from the oon(s)? Yes of No as any erosion observed? Yes o No
Is adequate land available for spray? Yes o No Is the cover crop adequate? Yes or(No)
Crop(s) being utilized: Cor o-EFF s,t .e Ld w,\\ C- lar.t� n ��or
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Y No LXk-
100 Feet from Wells? Yes of
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into water of� state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No _ NET Y!o ,,•n,_ �,� ���,f .
Additional Comments:
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-1�V.lIS .a.��• �or��c`c-L �RGS �o.t
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

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