780078_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual
OX)

r
type of visit: (y ompliance inspection U Uperation Review U btructure Evaluation U fecnnical Assistance
Reason for Visit: G Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: .� ,t Arrival Time: Departure Time: County:o b�
Farm Name: 1,01e,
2— Owner Email:
Owner Name: 1, a 1e, j St Phone:
Mailing Address:
Physical Address: Facility Contact: G t ici i `S_ ECcd`Gj 1`cA('__ Title: Phone:
Onsite Representative:
Certified Operator:
y
Back-up Operator: O Ql V i go
Region: T
Integrator: iw >3 —,S-
ZL
Certification Number: 11 Cy
Certification Number: ("V, 0 .3
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Poultry
Layer
I lNon-Layer
D . P,oul
La ers
Non -Layers
Design
Capacity
Ca aci
Current
Pop.
$o
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Wean to Feeder
Feeder to Finish
2
t
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes L3" 1V o ❑ NA ❑ N E
a. Was the conveyance man-made? [:]Yes [:]No ff�A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify D)VR) ❑ Yes [:]No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ Now NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes D o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facifi!x Number: 77- 7 V jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Qc .Dlu--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No M-NA❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spiliway?:
Designed Freeboard (in):
Observed Freeboard (in): Z !
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Qom- ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes n' Rio ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes [ZLN6'_ ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [] Yes Q'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 Cro'pr Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 1'3
13. Soil Type(s): JV 0 5f `T fl
14. Do the receiving crops differ from t4ose designated in the CAWMP?
❑ Yes
[]3<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
E j- w
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0-T;fo--
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
two
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
l N90
lEj
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

[FacHity Number: - '7 Date of Inspection: k
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [L�•Ado ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E]'14o ❑ 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
Kj".To NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[::]Yes
No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ER --No— ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Q'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
C No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D�<o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ETNo
❑ NA
❑ NE
Clzdl b 0'6JI'o l r 2- E/Uj t . �� try to -3 6 .a 2
6- �— S� Y3`�U
G -e _ _110 -30 8s- 6A St.
Reviewer/Inspector Name: 3 i 1( C) U4,L4 Phone: T(o- 33 3 33y
Reviewer/inspector Signature: Date: /` J "(:, ( K
Page 3 of 3 2/4/201 S

rv& 7�1
ion of Wa#er Resources
NicilityINuml er. .� - lg ®Division of Soil and Water Conservation
® Other Agency
Type of Visit: ID-Clompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 04outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: 13o P(ol, 1'71 Arrival Time: .Yd Departure Time: f U County: ✓ Region: f
Farm Name: �d �� S� �"sfr<c t�, Owner Email:
Owner Name: - a/c, r� s�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Ct'T f c/rt�ricC� Title:
Onsite Representative: C`
Phone:
Integrator: &g s — L
Certified Operator: "Ut'd 4&0,sr= Certification Number: /00/ P7I
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
- STCurrent
,Design Currents
= Design Current
Swine Capacity
Pop.l
Wet Poul#17 j Capac1tyPop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
2
Feeder to Finish
-2-SV
&140
Dairy Heifer
Farrow to Wean
Dry Cow
; Design Current
_ D �* It , a i. ac Ca W _I'o P.
Farrow to Feeder
Non -Dairy
Layers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke sOth
_:WE�„�, . �
P
TurkeyPouets
r Other
__
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes EJ-Na- ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
Q'NA ❑ NE
D-NA ❑ NE
[:]Yes
[:]No
[FNA
❑ NE
❑Yes
E]`N—o
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE.
Page 1 of 3 21412015 Continued

Facili number: - Date of Inspection:
Waste Collection & Treatment
4.4s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-NO-0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in) --
Observed Freeboard (in). ZZ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No
❑ NA
❑ NE
(Le., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
0 Yes
['90
❑ 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
[3-No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
['No
❑ NA
❑ NE
{not applicable to roofed pits, dry stacks, and/or wet stacks}
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [T No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): wt t� I�C✓`11 :SG � C (.rJ S
13. Soil Type{s}: �
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes Q'1<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [D<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑'1io ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [214o ❑ NA ❑ NE
❑ Yes �io [] NA ❑ NE
Required Records & Documents
19. Did the facility tail to have the Certificate of Coverage & Permit readily available? ❑ Yes [allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O-No ❑ NA ❑ NE
the appropriate box.
❑WISP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ET<es wo
❑ 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 ErNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LJ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Pare 2 of 3 21412015 Conhfnued

Facility Number: jDate of Inspection: YD
I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E!rNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
L1 110
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EfrNo
❑ 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
ff'No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
! aJ Ro
❑ 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
ffNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[/3 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
f] No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA ❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
77
L,a c 6� itu-� sF ti l �— 1 fa
4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1) << I Y C1'`-�1q
r
4
i I( Phone:ii c1 ` q� 333 i
c
Date: 3V
21412015

7
Type of Visit: (3�-omp a Inspection U Operation Review U Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 / Arrival Time: : p Departure Time: !; p County: Z0 I Region:
Farm Name: A-e2Z,% S r-cr /may lz�us� � Owner Email:
Owner Name: 40 gp ru5,L Phone:
Mailing Address:
Physical Address:
Facility Contact: O Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
no e P city Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Dai Heifer
Feeder to Finish
,VV
Farrow to Wean
Design
Current
D Cow
--'
Farrow to Feeder
D . P.oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other,
„
Turkey Poults
Other
Other
Discharges andStreamImpacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[:]No
❑NA
❑NE
❑ Yes ❑ No
[:]Yes © No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Ll*flity Number: - Date of Ins ection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5❑ 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): l t'
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[N No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
(�f No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
_a No
❑ NA
❑ NE '
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
Ja No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
ayes
[:]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
jo
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application of Approved Area
12. Crop Type(s):
/Outside
13. Soil Type(s): L Z / ,ge � f}-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[8-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
12 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffi-No
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Eallo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P5 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. aYes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �ZLNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: 3 ice/
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
k,25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
n No
❑ NA
❑ NE
❑ Yes
13 No
❑ NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
[—]Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes QC No
D Yes [ No
[:]Yes [R_No
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
Comments (refer to question #i): Explain any: YES answers and/or :any additional recommendations orany otlier comments
Use drawings of facility to better explain situations (use additional pages as necessary).
aL
4,17
was � A
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: D D
Date:
21412014
Page 3 of 3

s
Type of Visit: ff Com lance Inspection V Operation Review p Structure Evaluation () Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Il
Date of Visit: cS Arrival Time: a Departure Time: t� County :p Region:r OL
j
Farm Name: pL �1 'Z— Owner Email:
Owner Name: L___ `"P Phone:
Mailing Address:
Physical Address:
Facility Contact: _ �"4 tx — KL--fTitle: Phone:
Onsite Representative: l (
Certified Operator:
Back-up Operator:
Location of Farm:
� as
Latitude:
Integrator: Al
Certification Number: ! 00 131 q
Certification Number: ( Q 0 I �5 0
Longitude:
Design
Current .
Design
Current
Design Current
Swine
Capacity
Fop.
Wet Pointry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non-er
Dairy Calf
Feeder to Finish
2
{ I O ci
'"'`` ' '
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dry P,oul
Ca aci
$o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream IMDRCtS
1. Is any discharge observed from any part of the operation? ❑ Yes [tI N ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
Q NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E] A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
EfNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
-
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
[] NE
of the State other than from a discharge?
Page 1 of 3 21412014 Coatdnued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0_ [e--❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑'NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E] W
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
t
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[j 1 0�
❑ 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
�
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste AunGcation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Coe, 1 4 %r ^' S G c7
13. Soil Type(s): N L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UDXo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
Q'Na
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
I2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes�'No
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes 0211�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 6 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes J No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

IFaciHty Number: -7 fDate of Inspection: , G 1,5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
E f No
[DNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�lo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
'' No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ff 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
E�`No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
b No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers ,and/or;any additional recommendations -or anyother�comments.r
Use drawings of facility to. better explain situations (use additional'pages as necessary).
-
* 6 A A)DO
(f�tc
Reviewer/Inspector Name:Sk
;
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 13,
Date: 61)
21412014

Type of Visit: (ErComp ' nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
r
Date of Visit: LLq Arrival Time: Departure Departure Time: county: Region'l-/eV
Farm Name: Iti,W- • Z , Owner Email:
Owner Name: NotPhone:
Mailing Address:
Physical Address:
Facility Contact: f-- Title:
Onsite Representative: K
r+
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current III 1111gilillpliqDesign Current Design
C►apacity Pop. Wet Poultry Capacity Pop. Caltle Capacity
11
Current
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
I
D . P,oul Ca aci la
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other Turkey Poults
Other Other
Discharses 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 t__T"" ❑ NA ❑ NE
❑ Yes ❑ No [B-M ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [—]No Lj AA ❑ 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 [3 A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes C� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E!rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

r
Facie Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ELNo—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [J ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): en
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 05>g ❑ 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
[g-<'
❑ 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
Eg-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
L7 1V°
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes IvJ"<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): b Ccr- K"OL /�i ►� " JD G! (/'l
13. Soil Type(s): O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Car o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[al o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EffNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[5 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ej 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
[r]No
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ko
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

04, AA
Facility Number: -t jDate of Inspection: C
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Nlo' ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes Flo ❑ 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 [B-Na ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 10 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes ❑ N ❑ 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 d❑-3' U ❑ 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 to ❑ NA ❑ NE
❑ Application Field ❑ LagoonlStorage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [2'1o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes []a No D. NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes dNo ❑ NA ❑ NE
Comments (refer to question #1):: Explain any YES answers. and/or any additional recommeudations or.any otheerjcomments.
.
Use drawings olffacility °to better expWn!situations (iiWi dotional_'pages as necessary) 9- .
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 16 I" 3I
Date: C�_?
21412014

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Ql<outine O Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: .O Departure Time: County: �. Region: %2
Farm Name: Owner Email:
Owner Name: [�,� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: t—Gk•
Onsite Representative: 6dgn_ �
� `` ii
Certified Operator: Tet rl w � i 1 n Uss K D y
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: fi%y i j! •r J ro w kL
Certification Number: of ��-
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
La er
Layer
Capacity
Pop.
Cattle `-
Dairy Cow
Dairy Calf
Capacity P.
Feeder to Finish
Dairy Heifer
arrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Poultr . a
:Ca aci
Pa
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Cj� No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [—]No
[:]Yes KNo
❑ Yes 2[ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: 2- Date of Inspection:
Waste Collection Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RLNo
❑ NA
❑ NE
. a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�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
Callo
❑ 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
g[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[gNo
❑ 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
NNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O—No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [5j 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 Cropd Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):lm�+
13. Soil Type(s): .opt*
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 54 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eg No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
R_euuired 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
Z 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 5j� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 S No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: jDate of Inspection: Q --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D§ No ❑ NA ❑ NE
. 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [R No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
gg No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
54 No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes fg No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
[:]Yes No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
1Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Usi,dra vinjZs'of facility to better explain situations (use additional pages as necessarv). _` r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `: /t"'fi'�3
Date:
21417011

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: f - Arrival Time: Departure Time: County: �j�r_ Region:
Farm Name: , W( Owner Email:
Owner Name: a Phone:
Mailing Address:
Physical Address:
Facility Contact: E O C43Z_- Title: g)-r1in }- Phone:
Onsite Representative: t Integrator: _/k1,j4+1,-r
Certified Operator: 1 l Certification Number '
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
DelCprrent DesignCurrent
Swineop. Wet Poultry : ^ Capa rtyPop._
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
Layer
I
Wean to Feeder
Non- a er
1
Dairy Calf
eeder to Finish
- r
Design. CurrentDry
Ca'atEty I'o' .
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Cow
Non -Dairy
Farrow to Finish
La ers
113eef Stocker
Gilts
Layers
Beef Feeder
Boars Pullets
:°.. .. Turkeys
Other Turkey Poults
Beef Brood Cow
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes R[No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes U No ❑ NA [:]NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Z Date of Ins ection: /
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 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [A No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
(. No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E4No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No -
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s) Y� 1�7i5�% x�� i`�1 f �1517?t-1416'_n" 1
13. Soil Type(s): �7_
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 [Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Callo
❑ 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
5INo
❑ 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
� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(a No
❑ NA
❑ NE
Page 2 of 3
21412011 Condnued

Facility Number: - IDate of Inspection: ' t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E] No ❑ NA ❑ WE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If ycs, 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/Impector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [ 1a No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes Pg No ❑ NA ❑ NE
[:]Yes ® No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or --any other�comments
Use drawings of facility to better explain situations (use additional pages as necessary)., .. �_.
Reviewer/]nspector Name: SIYti� �xy�i~- Phone: g`ia
Reviewer/inspector Signature: Date: 1/1
Page 3 of 3 21412011

�' •Divission of Winer Quality
Facility Number ® ® ®DivisiRencvf Soil and Water Conservation f�.—I l
® Other -
Type of Visit: Q<6mpliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (511Koutine O Complaint Q Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time:' 0 Departure Time: 1 3:_50 i County: Region: a
Farm Name �� ;� p[,(.,s Z__ Owner Email:
Owner Name: goly A D Gcs Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative:Integrator: r
Certified Operator: ,t pLL
S e✓ Certification Number:,7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Curren_ f- Design Current
Wet PoultryCapacity Pop: Cattle Capacity Pop.
ELa er - DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
!'
VI Design Current
" D . P,oult , Ca aei Po , - -
Layers
DairyHeifer
D Cow
airy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
-
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Points
Other
Discharces and Stream ImnaCts
1. Is any discharge observed from any part of the operation?
❑ Yes
E�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[) Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: jDatc of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
(—]Yes
allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes a 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): .gev csr�3r�/G�Jv'�'L %GCJ,E ,c2�iyu
13. Soil Type(s): 11 b
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 [R No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes F�71 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6d No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permii conditions related to sludge? If yes, check ❑ Yes Ea No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CK No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
10 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
R_No
❑ NA
❑ NE
Comments (refer to question #). Explain any YES answers`andlor any additional recommendations or any other commen_t`s:" -eb
Use drawings of facility to better:-explain_situations (use additional pages as necessary):: __ - p
Reviewer/Inspector Name:
Revi ewer/] nspector Signature:
Page 3 of 3
Phone:3Jt�
Date:
21412011

c
IType of Visit 40"Compliance Inspection 0 operation Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit Or outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �z_1 ZO Region: 2Q
Q��] Arrival Time: t Departure Time: !(7 2 V County: g'
Farm Name: _ O� �. I`YA�� — , Z Owner Email:
Owner Name: /'J Oe,wS/e- _ _ % _ Phone: ,t
Mailing Address: '� u f / ► /] 0re1'.'..-tA
Physical Address:
Facility Contact: Title: �'- Phone No:
Onsite Representative: Integrator:
Certified Operator: 5-a ttl &&;$e - Operator Certification Number: 27 4,03
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = { = u Longitude: = ° =' 0
n Current
ZDA
Design
Current Design Current
acity Population
Wet Poultry
Capacity
Population C►attle Capacity Popularian
❑Dai Cow
❑Dai Calf
❑ DairyHeifer
❑ an to Finish
❑ La er
❑ an to Feeder
❑Non -La er
® Feeder to Finish-$1)Q
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Turke s
❑ Beef Brood Co
Other
❑ Turkey Poults
Number of Structures:
❑ Other
1 10Other
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?
El Yes 2<o ❑NA El NE
❑ Yes ❑ No E�NA
l�"NA El NE
El Yes ❑ No C_f ❑ NE
❑ Yes ❑ No "N,NE
dam
❑ Yes a ❑ NF
❑ Yes 94 ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — 7 Date of Inspection�;ikoa
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ly"1Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E o ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0<0 ❑ 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�J4 ElNA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[IYes
Zd 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
l<o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Eviden`cce of Wind Drift El Application Outside
of Area
f 4D
12. Croptype(s) Beyyt,_ f S� 1 SG.0, . �tir-�./
�twn.%r
�J
13. Soil type(s) /(Jo Q
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
[P<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
D No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NNoo
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,2
R<
❑ NA
❑ NE
Zltlle.,
A-5 I XAC-4�-4
�
PX�
die
cry
/
•t�xrf fcr- 2416.
Reviewer/Inspector Name
Reviewer/Inspector tgnal
Phone: j
Date: /6 02 7 /l
Page 2 of 3 �r V 12/18/04 Continued

Facility Number: — Date of Inspection 7
Re uired Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El9
Yes - o ❑ NA - ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes l ,14'o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Isd'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
U N'o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B' o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2To
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2 o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
To
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑'1Qo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I_I 5o
❑ 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
�
l�,_.,�tvo
❑ 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
Mo
❑ 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
-mo-
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,E
4J 'No ❑ NA
❑ NE
Additional Comments andlor Drarvmgs i._
.r,.
L
Page 3 of 3 12128104

dl_�
f�rN_5 CAWIVC1 s//411200q
ivision of Water Quality
Facility Number % g 7 B O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Cm opliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0-1 routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 07 -0 g Arrival Time: Z: d0 rvt Departure Time: `/.�ff0 County: A?0be_SOA! Region-
Farm Name: RQu.fe. 2 Owner Email:
Owner Name- a`, r �d tu e— Phone:
Mailing Address:
Physical Address:
Facility Contact: Z�� Rack+- Title: Phone No:
Onsite Representative: S<Y(' �'•► f � � �'' Integrator: 14 !4Q
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =] o =]' = Longitude: = ° [� { ❑ 41
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish O $OD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Nan -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
'
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Capacity Population
❑ Daia Cow
❑ Daja Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ED
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 ofthe State
other than from a discharge?
❑ Yes L'] No ❑ NA ❑ NE
❑ Yes
❑ No
ETNA
❑ NE
❑ Yes
❑ No
[3 A
❑ NE
NA
El NE
❑ Yes
El Yes
,❑lNNo
ErNo
El NA
El NE
El Yes
[3 o
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection S-C 7 - 09
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes B No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) , ��
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E! No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElL•'�hrYes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑yes [� N ❑ 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 &No ❑ NA ❑ NE
maintenance/improvement? j/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D 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 [I Evidence of Wind Drift Application Outside of Area
12. Croptype(s) Yi±tccCT 6GrYae Sirtai��oryiAr (O,S,� &,-,r - �JA,4,4-
13. Soil type(s) ID ,3 0,# L GO A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L7 lvo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes B No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
0'1io
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application? El[ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment'? ❑ Yes
B No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A6
w
Reviewer/Inspector Name Rf �e ve is Phone: qja. $33333Y
Reviewer/Inspector Signature: Date: S`07-29d
12128104 Continued

Facility Number: 79 —7 Date of Inspection 5-O7 -Oy
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BTo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes BTo ❑ 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
B No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1Vo
❑ NA
ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
,E
L J'No
❑ NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
B No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
��o
BN* o
❑ NA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
&o
[I NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElL_f Yes
,B
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
El 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
Vo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2<0
❑ NA
❑ NE
Comments and/or Drawings:
12128104

BTA15 e,,t kr -J y -i1-zoo$ !l_
Facility Number
0"D'ivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,,C,,ompliance
('Ron�utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 9--o-7--1001 Arrival Time: / : [] n•1 Departure Time: County: ,�pd Gsa.✓ Region:
Farm Name: 8,141, I'S OuS 'e— #2 Owner Email:
Owner Name: Alq!fNL /Izou Phone:
Mailing Address: 955 3arNc s v r I/(- _ _ C 44 rums , c
Physical Address: h
Facility Contact: <4 �!2 Aus4!w't Title: • S Phone No:
On site Representative: I�g S �iraGW �8���� gays-, - Integrator: &-zs aA.1
Certified Operator: Rouse— Operator Certification Number: 27f-5`%
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [—] e ='
=" Longitude: = o =' = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
2 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ 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 Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If _yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

r r
Facility Number: —7 g— 7 S Date of Inspection 3-07--6
Waste Collection & 'Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
El NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
M�, �NNoo
I<No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
BNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
�
2 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
o
❑ NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El1_� Yes
,2'
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,��
L�SNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) do Z A10A L y GoA
14.
Do the receiving crops differ from those designated in the CAWMP?
ElYes
�
Ergo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
2N"o ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
NNoo El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
�.,
l-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):
Reviewer/Inspector Name L eve.1.5 Phone: 110, *33 , 3300
Reviewerllnspector Signature: Date: 3 — 07 Zoo
12128104 Continued

Facility Number:'? —79 Date of Inspection 3'07-
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑ Maps
p [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 V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
�
LH"No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ Nam❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
El
0 NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
:�NoE]NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ETNo ❑ 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
ffNo ❑ 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
3< ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
erNo ❑ NA
❑ NE
Comments and/or Drawings:
12128104

'BIHS y1li,107
Facility Number 7 7 $
® Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: 3 -23-d Arrival Time: 3:10 nt Departure Time: ,`/Q County: ^1DVe50A1 Region: ` 9` o
Farm Name: L3:llu AA _Q St Fuva �2 i'DaOv w"S "u) Owner Email:
Owner Name: - �3� �1 � W � Qa U_t e._ Phone: #1/0, 740. 19 9
Mailing Address:
Physical Address:
Facility Contact: 1x4jCf^1 J Title: 7c4. Spec _ Phone No:
Onsite Representative: 14ia�i.� lbuaaa / gill, W, h�euec� Integrator: Af-'01.. U1"a:'1 ^
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e =1 = " Longitude: = o =1 = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
SZ130
OD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other- ---
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp_es & 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)
Design'
Cattle Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures.: C
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 M No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
1P' No
❑ NA
❑ NE
12128104 Continued

M
Facility Number: % — 7 $ Date of Inspection 3-Z3 -O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
YNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[9No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
(A No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No
❑ NA
❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window rr ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) J3e.Ykau.CLG.(?UStu �Nckl! �'►�,`� COvevS�cd� _ CovN idm�NU[a-�-
13. Soil type(s) NOB B NON GoA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
®No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes
99 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use of facility tco� better explain situations. (use additional pages as necessary):
Adrawings
l I
IRi3 c�c� J *,,,�j�-, S .t f'-'S 4- S 4f N/e�r�.S 17U4"1+--A4r)P -AV_ S V-
j
tL
3i�lyW i }GO� �11G� lS.f�►�'l GN AA-rLA %J .ZOO7-
Pub
OVvn�shi�
Reviewer/Inspector Name P1ek Re:Ve.I$ Phone: qW. Y33.3334
ReAewer/Inspector Signature: &
Qj= R Date: 3 - z 3 - 2 007
12128104 Continued

.. t
Facility Number: -7 Ig -7g I Date of Inspection —Z3-47
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [X No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P9 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
T No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
V1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
UsNo
❑ 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
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of visit: S-d9- p Arrival Time: 3 : Z i� Departure Time: 1 Q 0,J County: Region:
Farm Name: Q/y L-G_ts]i5 Owner Email:
Owner Name: 1)0nI LeuJ/s Phone:
Mailing Address:
Physical Address: f�
Facility Contact: /� 744 - u 4 tLtl Title: /�fPho_ne/No:
Onsite Representative: k'ag tw D uQQ►� lbaIV �e-141s Integrator: l/!ll�fi�/al.�%✓
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = n [ = = is Longitude: [= o =
Design Current
Design_ ,, Current
Design Current
Swine
Capacity _Population
Wet Poultry
Cannel P p ladon
C*attle Capacity Populatian
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish1_15-2'TOwY,r''
`' '`
❑ Dairy Heifer
El
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
1.
is any discharge observed from any part of the operation?
Discharges &Stream Impacts
1.
is any discharge observed from any part of the operation?
El Yes
Of No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
&No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
M No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑Yes
�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
13 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
$ No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
I2/28/04
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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
❑ NA ❑ NE
❑NA El NE
Structure 6
❑ Yes V1No ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes 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
Qj No [:3 NA
El NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
/
❑ PAN ❑ PAN > 10% or ]0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ A`pplication Outside of Area
12.
Crop type(s) ,�Py�u aka . �GSFirivt— 3N_l '7t99i7? 1W Gaverccej J Cob -Al AIIAl
fd,1 l6lt�d
13.
Soil type(s) /b�, R No X L , j
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
V No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
00 No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
% No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
;4No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
$No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comm ents. R
Use drawings of facility to better explain situations. (use additional pages as necessary)
A,
Reviewer/inspector NameG e.�l�S Phone:
(yla, -3300
ReviewerAnspector Signature: Date:
5-e79-
Page 2 of 3 12128104 Continued

Facility Number: -7,T-7XI Date of Inspection T- -0
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [M 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
[,M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
29 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�MNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesVU
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
0 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
[ allo
❑ 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
�FNo
❑ 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
(PPNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[I Yes
V] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ®Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit e Routine O Complaint O Follow up 0 Referral O Emergency O Other ❑Denied Access
Date of Visit: Arrival Time: ©S Departure Time: County: e6 Region: Flet)
Farm Name: IMP M�tE �✓ Owner Email:
Owner Name: �o�" 'LeA JtiS __ Phone: 11
Mailing Address: �91 &2 �� e0Ad �QMrYy. N _ 28
Phvsicaf Address:
Facility Contact: Title:
Onsite Representative: �-k'v ! dAM.
Certified Operator: 1>
Back-up Operator:
Phone No:
Integrator: h,..._-_ cj,n tr _
Operator Certification Number:��
Back-up Certification Number:
Location of Farm: Latitude: [= n = 4 = « Longitude: = ° = I = tt
Design C,uirent i� Desigu < 'urrents Design Current
a
rffle' Ca�pa v PPoopulahon ;'. Wet Poultry Capacity Populahon> Cattle Capacity Population
ean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -La et
Feeder to Finish
���
❑ Farrow to Wean
,D�yiPoultry "".,
❑ Farrow to Feeder
❑ Farrow to Finish
PO
Gilts Boars i,r
-Turkeys
Other,
❑ Other �` Number of Structures:
❑ Layers
❑ Non -Layers
❑ Pullets
❑
❑ Turke Poults
❑ Other
Discharges & Stream impacts
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
I . Is any discharge observed from any part of the operation?
❑ Yes
0No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[-NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[RNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
❑ Yes
❑ No
09 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility umber: " ---4-b j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes ❑ No [R NA ❑ NE
Structure 5 Structure 6
❑ Yes [9No ❑ NA ❑ NE
❑ Yes 9§ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [Z No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes IQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 > l0% or t0 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) OPiM'LtIdG — h�c�S Cos�n
r �1.i x 92.4.0 --
a
13. Soil type(s) No.@. LLAL
Li , t f o A Ly
_
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
14 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination' ❑ Yes
6ANo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L No
❑ NA
❑ NE
Reviewer/Inspector Name MENEF00l�f-t� ; Phone:
Reviewer/Inspector Signature: Date:-
12/28104 Continued

Fiacility Number: qb — -9 Date of Inspection 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ►[g-No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E§No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit? /JYb
❑ Yes
A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EjNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
91 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JQ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
09 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
WNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9[No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance 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 OfVisiL. Tune:
Q Not Operational Q Below Threshold
12 Permitted ® Certified 13 Conditionally Certified rj Registered Date, Last Operated or Above Threshold:
Farm Name: County:
OwnerName. _ o A.- L r ��i� _.. Phone No: S �a G Q—
Mailing Address:
Facility Contact: - . Aa N_._ c w_ . Title: Phone No.-
Onsite Representative: ,14p ,IV _ 2 r�- � M Integrator: _ tj%r .. ^ BY,Q f i 2 ►2
Certified Operator: a v _ _„ c w Y s Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry 0 Cattle ❑ Florse Latitude ' Du Longitude �• �Cc
Discha*aes & Stream mitts
1. Is any discharge observed from any part of the operation? ❑ Yes rV No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'? A/.4
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No R
2. Is there evidence of past discharge from any part of the operarion? ❑ Yes IR No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3d �r
12112103 Continued

Facility Nugaber: , ' _ 7S Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes U No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 09 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes P No
S. Does any part of the waste management system other than waste structures require maintenancefunprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ( No
elevation markings? 1
Waste Aunfication
10. Are there any buffers that need maintenanceftmprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop typerirs�c �ia� //+r..A .e ZSG'.d�%',h..�• . �. ll��.�. sec.6•�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [P No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes P No
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes [� No
15. Does the receiving crop need improvement? ❑ Yes [V No
16. Is there a lack of adequate waste application equipment? ❑ Yes qNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1P 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 P No
Air Quality representative immediately.

Facility Number: 7� Date of Inspection
Required Records & Docnments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes W No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, reaps, etc.) ❑ Yes to No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes K] 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 O No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes FXI No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 10 No
27. Did Reviewergmspettor fail to discuss review/inspection with on -site representative? ❑ Yes [RNo
28. Does facility require a follow-up visit by same agency? ❑ Yes IM No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
MIMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 01 Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EU No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5a No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [A No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ® No
35. Does record steeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 10 No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Foam
12112103

Type of Visit ® Compliance inspection O Operation Review C) Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint O Follow up (:) Emergency Notification 0 Other ❑ Denied Access
Date of N'isit_ a 0 Time:
Facility Number
L • - •— .., - � Not O erationai Below Threshold
® Permitted ® Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm -Name: __ n (;, Let C RG ty' ., Counrv. az::. �P d
Owner Dame: ��.n Lz�'3 F Phone No:
Mailing Address: , ,am (rr,} ryk At . c,_
Facility Contact: D/, y` La,-, i C Title: -_ P ' -w� Phone No:
Onsite Representative: Integrator: r`r`C
Certified Operator: D & ,.. L 2 -w k- Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' » Longitude ' �• 0�
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
® Feeder to Finish
rd
❑ Farrow to W-ean
❑ farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
-Holding Ponds I Solid Traps
Design Current Design Current
Poultry Ca acitti Population Cattle CR1DRCi1tV Po elation
❑ Laver I ❑ Dairy I
❑ Non -Laver I ID Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present ❑ La oon Area Spray Field Area
} ❑ 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 ves, notify DWQ)
c. If discharge is observed. what is the estimated flow in Rallmin?
d. Does discharge bypass a lagoon system? (If yes, notiffi, 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 S 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): 3 3
05103101
❑ Yes © No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 153 No
❑ Yes ®No
❑Yes qNo
Structure 6
Continued

Facility Number: Date of Inspection t3 b3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes Q 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 Q No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes W No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Apolication
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 �eI`m u'd c
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes q No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes CO 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? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
n-, No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
P0 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
W No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[U No
0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this viisiL
Comments refer to uesdoii'#R lam arL n YES answers an' or an reconimendahons or an other comments.
ffi&_.9
Y a . - ii: ✓3 '3' 5. _ `yam
-__ *'.,5
Gt1'rv�, rf' C& rJo +- 14 be b" dc'e'Q r
+t z S
Reviewer/Inspector Name }
Reviewer/Inspector Signature:
05103101
❑ Field Copy ❑ Final Notes
Date: 1 ajos43
Conrinued

+1 1
Facility lumber: -Ig — " Date of Insproitin O.
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 anv 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 submersed fill pipe or a permanentltemporary cover?
Additional' Comments andlos:Dr2wings ` _
05103101
N Yes ❑ No
❑ Yes ® No
❑ Yes allo
❑ Yes V No
❑ Yes [R No
❑ Yes [5bNo
❑ Yes ❑ No

w
Type of Visit & Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 4D Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit: •ime:
Not O erational 0 Below Threshold
® Permitted 0 Certified [3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: County:
Owner Name: L r,�/ems' / Phone No: L y/0/ 6�2_,P 9a�7
Mailing Address:
Facility Contact: %�.t-✓ lam- �f-� _ Title: Phone No:
Onsite Representative: — D, Integrator: G�l ->• ..�
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude 0 ` E� a Longitude Oo •
-Design R Carireiit -_ Design "Current " Design Current
Sue ". G acii� -Po� utatton-=PoutdrvC� achy Po itEatibn _, Cattle _ _= <Ca arity=.Po u]at,on --
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish 2 Z ; ❑ Non -Laver r-
[] Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish ,Total Design Capacity ,
❑ Gilts
❑ Boars = T©tal SSLW
Nttmber of Lagoons :?©5 = ❑Subsurface Drains Prent ❑ La oonesArea 10sprav Field Area
Holdiiig'Ponds f SoUd;Traps = _ ❑ No Li uid A'aste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ 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 gat/min?
d_ Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 27
OS/Q3/DI
❑ Yes ® No
❑ Yes ® No
❑ Yes ,Q No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
R No
Structure 6
Continued

Facility Number: 78 — ;7
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 anv 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 t No
❑ Yes [9 No
❑ Yes No
❑ Yes No
❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes NNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PLAN ❑ Hydraulic Overload ❑ Yes WNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ElNo
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 [SNo
15.
Does the receiving crop need improvement?
❑ Yes
29:No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
(dNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP design, etc.)
❑ Yes
No
checklists, maps,
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ YesFNO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
ANo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EYNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
El No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
T
CIO ments{refer-to;,questzoii #) Explainy YESiinsRe> s and/or• a } reeommendatrons or ativ outer coaeme�ats - -
irse;drawtngs of fiacilrty to better cxpltun sttuattoaas<(use addttxonal pages as n�esessaty) Field Conv ❑ Final Notes
7/0 WI11 4�_ i
r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /o Z o Z
05103101 Continued

Facility Number: 7
,;p pate of iespu
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [I Yes ONo
liquid level of lagoon or storage pond mith no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 93 No
28. Is there any evidence of wind drift during land application? (i_c. residue on neighboring vegetation, asphalt. ❑ Yes JZ 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 9 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 P-No
3 I . Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes No
Additional comments andloeDrawin^s:;= - _ - -- - -- - -
05103101

Type of Visit (ts Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Complaint. O Follow up O'Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: %�� Time:
Q Not O erational Q Below Threshold
P(Permitted ❑ Certified p jConditionally Certified 0 Registered Date Last Operated Above Threshold:
Farm Name:. Q� ✓� ..: lr"-..1 ......... ...W........._ County: .......,t 1,al,f�
OwnerName: ..... b...................................et .... ............................... Phone No: ........... kr.�r;4 .. .I. d ...........__
Facility Contact: ............ � Phone/N6
Mailing Address: ........ ......C......_........................z____
Onsite Representative:_ r` integrator:Q.r
— y..................................................... ...---.......... !
Certified O rator• AOA C / ...... ... W _ .....................Operator Certification Number: .............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �u
Design.: Current' -Design ;'Current ": Desrg<r Current
Swrae ci Pa ulatsoo; Poultry .Caaacrty. Ponniatioa Cattle Canacitv..Pooalatioaa>`
Wean to Feeder
Feeder to Finish
z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
'El Gilts
El Boars
Number of i,sigoons ❑ Subsurface Drains Present Lagoon Area ❑ Spray Field Area
Holdrng Ponds /Solid Traps No Liquid Waste Management System 5 t
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 1po
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) [] Yes
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 ,lf No
2. Is there evidence of past discharge from any part of the operation? El Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A�o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................
Freeboard (inches):
5/00 G
Continued on back

Facility Number: — 7� Date of inspection 7 -6 Printed on 10/2612U�0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes � No
(If any of questions 4-6 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 C �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? , ❑ Yes �'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes f1Vo
Waste Application /�
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? j ❑ Excessive Poon�ding ❑ PAN ElHydraaulic�erload ❑ s / o
12. Crop type &rMtjo._ rGt.S`t'L�trP_
13. Do the receiving crops differ with those desigri�ted in the Certified Animal Waste Management PIa�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 kNo
c) This facility is pended for a wettable acre determination? ❑ Yes _\KNo
15. Does the receiving crop need improvement? ❑ Yes P'No
16. Is there a lack of adequate waste application equipment? ❑ Yes ;i(No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
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
gNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
bf No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
j(No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(tNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
WNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o riblatioris ...... ra" •were I1004- d(ring this:visit. • Y. 4 will -r. eeeire iiti further
corxes deiTce abotit this :visit . .... :: ..... .
Comments! ('refer to question #) _ Expl -alpy .YES answers and/or any recommendaiions or any_ other comments _
_
_ ecesUsed'awugsoffaciii to better ex Wn_situations. (use additional pages as nsary -. .
oeeh Xgve beeA spr41 ej.
f�rm )OOA5 j6ad.
IV
Reviewer/Inspector Name J42
Reviewer/Inspector Signature: Date: 7— 24 — D/ 5100

r
Facility Number: Date of Inspection —o Printed on: 10/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
N0
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
o
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
o
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
`)�To
�
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
-2NVo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
J No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yeso
[Additional-Cornments:an or° .sawmgs' _ -- --
J
5100

Division of Sail and Water Conservation ':Operation Review s
.3 ]Division of Sail and. Water Conservation -:Compliance Inspection = e
B D visionof Water Qttaltty .Compleance lnspectZan #
" Other Agency,-,-.Qperahon Review r t-
® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection 1
Time of Inspection j !vd 124 hr. (hh:mm)
® Permitted [] Certified 0 Conditionally Certified 0 Registered JE3 Not O erational Date Last Operated:
FarmName: .............1�)e ....f Ali%..... '. `. ............ ................................. County. A16............................................
Owner Name: .... ....Gc1! ........ Phone No:...C....../..... r�-ZV..497..........................
�II r..........................
Facility Contact: ......IDe9 .-.....L `G.� ...................... Title
/:................................................................ Phone No:...................................................
Mailing Address: 487 ,E�r� �u��c w— � ��
G'........................ f.N......:....�............-
Onsite Representative:......./),a, Integrator:..... /�
Certified Operator :..___.t2Ay ,.,E(,,.,, ,•......I,, (, � ... Operator Certification Number:
Location of Farm:
r................................................................ ....... ....I.......................................................................... ... ...........
r r
Latitude • �� C�,: Longitude
Design Current Design ;Current Design= . Ctirr`ent i
Swine
Capacity Population ... Poult " -
-_>Z Y _ Capacity._ Population Cattle Capacity Population
❑ Wean to Feeder
EaFeeder to Finish
U
1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does- discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
[:]Yes )(No
❑ Yes KNo
❑ Yes ERNo
❑ Yes
RNo
❑ Yes
P,No
❑ Yes
® No
❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ,33
........................ ............................................................................................................................................. ..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
3/23/99
Fs-IMM
Continued on back

Facility Number: 7 p — 7,f Date of Inspection 0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes NLNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Wo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes RNo
Waste Aaalication
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
I I - Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes 4kNo
12. Crop type yfZ�.��Cp_ Tf�i�t!��.r�2A✓�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes CKNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes NNo
b) Does the facility need a wettable acre determination? ❑ Yes Po
c) This facility is pended for a wettable acre determination? ❑ Yes j —No
15. Does the receiving crop need improvement? ❑ Yes JqNo
16. is there a lack of adequate waste application equipment? ❑ Yes ANo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
,'Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
�'No
L `tNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
tfNo
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?
(iel discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
F)EI No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
yibla(ioris or• ¢e6ie, notes vtzere noted- du -ring th'is'
:visit: • Your will •teceiye ititi #' 41b' r • : •
CO ' Spo�ideitce ab, k this visit: " .... ...
Ed
Reviewer/Inspector Name
Reviewer/Inspector Signature:.. Date:

�
N
Facility Number: — P
Date of iiLspection Lt
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
tiallo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
&T.No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
PsNo
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.)
Cl Yes
J9 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
)ffNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
INo
- Additional. -Comments an or' _rawLrngs:-_
•

10 Routine Q Complaint Q Follow-up
of DWQ inspection Q Follow-up of DSWC review ABLOther
Facility Number
Date of Inspection:
1.��
—j
Time of Inspection
� 24 br. (hh:mm)
0 Permitted 0 Certified © Conditionally
Certified 0 Registered
113 Not Operational
I Date Last Operated:
Farm Name: ........ -!4 .4�i .f,s..........Fgr
.I,
County
A�es.(Irl .............................................
]�•+�--
Owner Name: Aaew
............................................................................
1If
L—r
Phone Na:...........................I.....,...........
Facility Contact: 6 W +1 err Title
Phone No .
MailingAddress: ...........................................................................................
Onsite Representative .................................
Certified Operator:......................................................................................
Location of Farm:
...... ............................................................. .......... .........................
Integrator:cq,!'o„S
...........................................
........ Operator Certification Number: ..........................................
Latitude �' �° ��� Longitude
Design Current Design Current
Swine Ca aci<ty.2
elation
❑ Wean to Feeder
Weeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity. Population Cattle.!.
❑ Layer ❑ Dair3
❑ Non -Layer JE1 Non -
Other _
-Total'Design Capai
Total SSL
Current
v. ;Population
Number of I.agootis
10Subsurface Drains Present J10
Area
Lagoon10
A
Spray Field Area
r
v
Holden `Ponds / SoltdtTra
g p
�r 11
j
❑ No Liquid Waste Management System
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'!
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State'? (I1* yes, noti fy DWQ)
❑ Yes
❑ No
c- If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, Notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
❑ No
«'aste Collection & Treatment
•I. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
%No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: /r
2,3
Freeboard(inches): ...................................................
...................................
5. Are there any immedi eats to a int rity of any of the structures observed? (ie/ trees, severe erosion,
[IYes
❑ No
seepage, etc.)
3/23/99
Continued on back

Information contained in this database is from non agency sources and is considered unconfirmed.
Farm Emergency Call Form
Farm Number
Farm Name Dan Lewis
Owner Frist Name jDan
Owner Last Name ILewis
OO Reporting O Complaint
Source jDan Lewis
Date
-1-2000
Time
Call Number
1 rJ
Breached
10 Yes ONO I
Freeboard Level 1 119
Depopulated
O Yes Q NO
Freeboard Level 2
Overflowed
O Yes ONO
Freeboard Level 3
LO Issue
10 Yes Q NO
Freeboard Level 4
PermissionToPump
Q Yes Q No
Inudated
Q Yes Q No
Freeboard Level 5
Flooded
O Yes Q NO
Freeboard Level 6
Pumping Equipment
10 Yes ONO
CommentsEnter.ed..bv.,leffe.❑r-13rawn.................................................................................................................................................... ------------

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Dan Lewis
Dan Lewis
2087 Bethesda Ch. Rd.
Omam, NC 28369
Dear Dan Lewis:
IT
4;A.
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NAT-URAL RESOURGE5
December 30, 1999
RECEIVED
,1 A �1 5 2000
FAYETTEVUE
REG. OFFICE
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 78-78
Robeson County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRR1, IRR2, DRY], DRY2, DRY3, SLUR1, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerely,
Kerr T. Stevens, Director
Division of Water Quality
cc: Fayetteville Regional Office
Robeson County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycle&10% post -consumer paper

r� +
Divesion oUSotl and Water_Conservation"--Operation Review
Divisi6 -.6f Soil and Water' Conservation - Compliance Inspection,=�
Dwision of Water Quality = Compf�ance Inspection
Other -Agency Operation Review _
Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSIVC review 0 Other
Facility Number Date of Inspection
r Time of tnsperction j 24 hr. (hh:mm)
*Permitted © Certified 13 Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: ..... ..Q h....... L e t 5-.-...Ca r!1!1 .................. County:.........Xo�� ....... - .... ........--.-......
OwnerName:.........!` Lew,.. Phone No:....-.... /..... %........................................................................................................................................ !� Z ... ��
Facility Contact: ............zqk ,. LQl� ..Title: Phone No:...................................................
7 .......... f.{.......j............................. �J �( ............. ��......................� q
itlailing Address: ........G g.-7....1.1.'.!.h'Sq...,....i�.C7r.......................... ......�..1'a;u'tti .... C............-.......-.... z6...1.....
Onsite Rep resentaLive: .-..�. Q) ....... ............ .. . Integrator:....... ?�YT) l...f...................................
Certified Operator: DC L i...............................
s Operator Certification Number:
.... .......
Location of Farm:
.. ......... ................................................................................... ................................................................................. _-.....-......................-......................................................... �J
.............................. ..................................... .............................................................................................. ............................................................................................................
Latitude Longitude �• ���°°
Design Current
awme
❑ Wean to Feeder
J�FFeeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I JE] Non -Dairy I I-,
❑ Other I I
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance Dian -made? ElYes 4 No
h. If discharge is observed. did it reach: ❑ Surfacc Waters ❑ Waters of the State ❑ Yes E�No
c- [f discharge is observed, what is the esunlated flow in t<al/ruin'?
d. Does discharge bypass a lagoon system? [:]'Yes'
Yes kNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes )�rNo
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes j�'�Vo
Waste Collection & rreatnient /�
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
I'CCL'hl)ai'd (InCliL'5): .........Y-D.....................................................................................................................................................................................................
1 /6/99 Continued on back

Facility Number: — 7g Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑YesNo
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 PfNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
S. Does any pact of the waste management system other than waste structures require main tenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes Wo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes %No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑Yes �No
/�
12. Crop type ......................... rrf't1 uc a STD / 441 Ca✓e�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes
\'N\ o
15. Does the receiving crop need improvement? ❑ Yes M No
16. Is there a lack of adequate waste application equipment? ❑ Yes W No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ANo
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ANo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ,tYes io
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 certified operator in responsible Charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) Oyes 7fNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0 No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
O.vicla"tions'or. deficiencies .were nated during this: visit:. Ynti-oA11'reeeive ita further
• correspattidence: about: this ;visit... ... ... .. ......... ... ... .. .
Comtitents.(refe'r to question #): Explain any YES answers andlor any recommendati6ds or any other comments.
Use drawings of facility to -better explain situations. (use additional pages as necessary):z -_
IVee qc�— eut�ren waS�e a�al�siScr l'ca7�i"mom-
P� r 1 J
�ses• J /% /�Ll,,, C1�lS 1l/� VJreC1614 COoer, rap P
%yir• vl'CU��t /TC�9 l� Nil f�l Gal, liGe/O 'Ado /LG✓r,�q C Itr�tia,ti (r'ciST�
�i�• Sa-m e 4t1� ap� , ca �^-- �'` W 1 1 ` J
CcKa[�5�5.� n,-p�rI�eti
Use
�1i�fe /��U� Kp I�'S f ��JJ ''IIJJ p
ja,54' � //Ar- or- i�a,oe ?J(� re,J SJ — �i5 15 AV OL)e- L't1Oci, 4ii tj4et� 1S—
rr•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
6
Date: 11/6/99

..
13 Division of Soil and Water Conservation [3 Other Agency
Routine O Complaint O FOIIow-uD of DWO inspection O Fotlow-up of DSWC review O Other
"Date of Inspection
Facility Number
Time of Inspection 1 #4 124 hr. (hh:mm)
Registered 9Certified © Applied for Permit o Permitted p Not [? eratinnal Date Last Operated:.....
.!
nn
Farm Name: t,J4.!1.................. kc7 ......5�..h....---- .......................
L.................................I..................
Owner Name: nn -- .... Phone No:
l.IE1............. .............
Facility Contact: ................ Teirc.......... Title: ... .... .................. Phone 1!o•
T
Mailing Address: .............a d g.,.l.,..._.... ol-...... Nl -.. Q,�Jl"'M G a � 4 ...... .... yr ..........I .................
Onsite Representative:..--------1-�n L--e�nl s S �DS�e L Integrator.:.... J �• lC-�
............................................... r'
• u --
Certified Operator;................ .... ./lJ.......t i' : .......... Operator Certification Number ......................................... ............................-..... -. :5.......
Location of Farm:
Latitude 0• ' " Longitude �' r_�` "
dk r " •
rgtl trip Design urre` `;'m nrrent u t nt
Siviue,;,ti,.;"Capacity,Popnlatton,
Poultry Populatton Cattle_ �CapactyF=Population
. Ng:Capacity
❑ Wean to Feeder
❑Layer 7.110Dairy
..
Feeder to Finish
aZ Sj9ZO A' ❑ Non -Layer ❑Non -Dairy
:ter❑ Farrow to Wean
•,.. #�«.; ;<� .;..:-
❑ Farrow to Feeder
❑ Other ;
Zrl
j
❑ Farrow to Finish
Totat Design CapaClty
.' El Gilts
TotaiSSLW
Boars.
Number of Lagoons 1 Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
� 'eik P-w�6 +��iX' F=-h'0.Cff'°} Ek'.'�i4''#��' � �3",a. fiq �i .... .. -....- ... .. .. a�'yx-�i'"'iyq outi.'.Yil➢Y*dr �. K.
❑ No Li Waste Management S
�,R�-
uid stemr�°
9 Y �_�
.
Genera
1. Are there any buffers that need maintenance/improvement? ❑ Yes WNo
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ;VNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes IN No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes A(No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ( No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

r
Facitity \umber: g — 7�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLagoons.Ifold itte Ponds, Flush Pits, etc'.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard tfty .......................................................
10. is seepage observed from any of the structures?
❑ Yes XNo
❑ Yes XNo
Structure 3 Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12., Do any of the structures need maintenance/improvement?
(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 entering waters of the State. notif)i DWQ)
❑ Yes XNo
❑ Yes ; 'No
❑ Yes 0No
❑ Yes X No
❑ Yes Xio
p� I
15. Crop type !v! SP..N f---� ..- ... ~...-�..?!1 t..----....-�� YL.......'
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. tIs there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/[nspector fail to discuss review/inspection with on -site representative.,
r
22. Does record keeping need improvement? -
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
[] No.violations or deficiencies were- noted- during this visit. Y&U.will receive no further
' correspondence about this, visit:.:.' _
❑ Yes 01N0
❑ Yes 9(,No
❑ Yes X No
❑ Yes J9 No
❑ Yes ZNo
❑ Yes 10No
1KYes ❑ No
❑ Yes UrNo
❑ Yes V(No
❑ Yes EKNo
0
Cbniiuents (irefei to question'#): ,Explain any TS answers and/or'ati rerotmriendations or any other comiments
Use;diawtngs of facility to better explatti-situatiotv4. (rise additional pagt-s a5 necessary) ` .'
v ..,:-
2a AL
i PAA)
CA wr►rrP. �41� A.t-c A� � Pvv
a 5., Cam- . t
7/25/97
Reviewer/Inspector Name rt
Reviewer/Inspector Signature: 1// -04, Date: (� �lt/�oVAO

FFacility Number
Farm Sbttkts:C-4.,,4.:
of DSWC review 0 Other
Date of Inspection
Time of Inspection Use 24 hr. time
Total Time (in hours) Spent DaReview
or Inspection (Includes travel and processing)
Far.Name:4 r4 L-q tz s
county: OIL
Owner Name- h,*N Lew; s phone No: 91b) (o-ZIY-9097
Mailing Address: I ZL r r LA e.-, ?3k2
Representative: Lewis Lewis btej�.-. Cczrrot(',5
Certified Operator. is OperatorCer0cation Number. J77
Location of Farm:
Latitude Longitude
10-Not operational _ 1 Date 140 Operated:
Type of Operation and Design Capacity
C
R Xf,
umbtr-R-WE�-V
Non -
Wean to Feeder
Beef' Feeder to Finish 57J 0 Layer I
Farrow to Wean
F to Feeder
Faw to Finish
'13 Other Type Of LiVC5t0ck
: ' Number of Lagoons !Holding Ponds: Subsurface Drains Present
rL1 spray FM
buffers
I Is any discharge observed
any part of the operation?
from
a. If discharge is
was the conveyance man-made?
b. If
no* DWQ)
c. If discharge is observed, what is the estimated
ow in gaLknin?
d. Does
notify DWQ)
observed,
discharge is observed, did it reach Surface Water? (If yes,
fl
discharge bypass a lagoon system? (If yes,
3. Is them evidcz= of past discharge
any part of the operation?
from
4. Was then any
a discharge?
adverse impacts to the waters of the State other than from
miinteriance/improvement?
S. Does any pan of the waste management system (other than lagoons/holding ponds) require
C) Yes XNo
E3 Yes
No
E3
K
E3 Yes P.(No
�No
Yes
13 Yes KNo
13 Yes PNo
13 Yes RNO
Yes &0
I
CojWnued on back

G. Is facility not in compliance with any applicable setback criteria? ` - ] Yes �40
7. Did the facility furlto have a certified operator in regmm'ble charge (if inspection alterUI/97)? 0Yes No
B. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes a
Atroetures aAeoons and/or Holdfa Pandsl :
9. Is structural freeboard less than adequate? 0 Yes o
Freeboard (8): .i.e�oaa 1 Lagoon 2 Lagoon 3 Lagoon 4.
10. Is seepage observed from any of the strerzttars? 0 Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures needTn*int ❑ Yes ANo
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
.13. Do nay of the structures lack adgvate martin to identify start and stop pumping levels? ❑ Yes ANo
A-'aste Apalfrntion
14. Is there physical evidence of over application? 0 Yes #No -
(if in excess of WMP, or ruaaff eatenn waters of the State notify DW r�
15. Crop type r� u.�o� rah O r eV .
I & Do the active crops differ with those designated in the Animal Waste Management Plea? 0 Yes 2Zdo
17. Does the facility have a lack of adequate acreage for land application? 0 Yes 010
18. Does the cover crop need improvement? D Yes ,dNo
19. Is there a lack of available irrigation equipment? ❑ Yes ANo
For Certified Facilities_Onh
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? 0 Yes "lo
21. Does the facility fail to comply with the Animal Waste Management Plan in any way? Cl Yes *0
22. Does record keeping need improvement? 0 Yes jEjNo
23. Does facility require a follow-up visit by same agency? 0 Yes ,(No
24. Did Revicrwer/iaspector fail to discuss reviewhnspection with owner or operator in charge? 0 Yes ONo
- - • r:
Couimeats1(7fer ro question 0 cucr;Ezpl
gsain;airy YE5 answas'siid/orazty rccosumezidatroas s:air other conzaaeaLs:: �� r �.
IJse'draizi�of facdrty to bclainsstua>s ;(iise adiina�:pages ns necr5�� ?
/ Q,t� '0"
•
Reviewer/InspeMr Name
Reviver/Inspector Signature:
cur Division of Water Quarfiry,4ftter Quality Serdlon, Facility Assessment Unit
Date: s-2-3-517
11/14/96

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. Dan Lewis
Rt. 1, Box 122
Orrum, NC 28369
Dear Mr. Lewis:
IDEF.HNF:Z
DIVISION OF WATER QUALITY
June 2, 1997
SUBJECT: Annual Compliance Inspection
DHL-Page Farm & Dan Lewis Farm
Registration No. 78-78 & 78-90
Robeson County
On May 20, 1997, staff from the Fayetteville Regional Office of the Division of Water Quality
inspected the subject swine facility. Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office based on the information provided and
observations made during the inspection that the facility was in compliance with 15A NCAC 2H,
Part.0217 at the time of the inspection. Please refer to the comments section on the rear of the
inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for a
minimum of 250 hogs must have a certified waste management plan on or before December 31,
1997. The district NRCS office, Agriculture Extension office, or the Division of Soil and Water
have specialist available to assist you with upgrading of existing facilities and certification.
If You have any questions concerning this matter, please call John Hasty at [phone].
Sincerely,
/2oh�n. Hasty, Jr.
Environmental Specialist
cc: Operations Branch
Central Files
Audry Oxendine - FRO DSW
Ed Holland - Robeson Co. NRCS
Wachovia Building, Suite 714, Fayetteville y.FAX [phone]
North Carolina 28301-5043 Nil
6 C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 W% recycled/10% post -consumer paper

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b. 8 heft not in as VbMae with say 1ppiiabl0 new* aitaia?
7. Dud the Sc iiy 69 to bavo a cortifiod opwaW In sr g=Ole &xW (dtN Uil9iM
- 8. An there iagovas or amp panels an titre wbirb nod to be pmpa?y dosed?
Stractores AtV ns SM&M Holdlna Fortdsl
9. h stnrcmral iicd=rd kss shin adegaw?
Freeboard (to: I Lgoon 2 1 agaaa 3
10. L soepaq<e obsaved f m any af&vkucbz=7-
11. Is sa imm, army otha grits b �e isic�rity ofarty of dw strawn obs ved?
12. Do any of for structiars need n -
(If any of questions 9-12 was answered gar, and the dtuadon poses an
immediate public heahb or environmental thread, savvy DWQ
.U. Do say of the souewa lacy adqute markers to identify start and stop pumping kvah?
Wa#S ApPlIcadon
14. B slum physical evidence of over appficafiaW
Of is cxcm of VIYT. or rno wiftss of the 5 notify DW
35. w►.L+.d`C►L C o r
�P ti'Pe
I0. Do the active a c t differ with those desigaatsd in the Aaimat waste MansgsmM Plan?
A 'Does the facility have a lack of adequate savage for Ind application?
18. Does the court crop need imgravemftV
19. is there a lacy of available irrigation equipment?
For Certified F�rdlitieY Ot,iv
20. Does the facility fail to have a copy of the Animal Waste Mmgcmt nt Plan readily ava0sble?
21. Does the bcOry fad to comply With the Animal Waste Maaagement ?In in army way?
22. Does record beeping need krovemeat?
23. Does ficHity require a follow-V visit by um armcy?
24. Did Revim=Ih Spector fail to discm mviewrnapection with owner or operator in eb W
t7 Ya
13 Yes No
i] Yes
Q Yea�o
Lap000 4
13Yea No
Q Yea IN.
© Yes fi(No
Q Yes ANo
13Yes ,gNo-
a Yes
Q Yes
13 Yes ,Wo
Q Yes 0 No
iD Yea W!o
Q Yes
Q Yes ANo
Q Yes 216No
Q Ya OWo
Corriments (refer to qucsteon.il�: Explain anY YES I ons.aa• nay ortber cowcats;. S . ;w
Use+dk.m ,qAgyYp c.PW, NiWYVYa.�� � iw/ _ �i6/.x.�:•. i:'. - 3`'r ...i Mom. -
a
ReviewwIIuzpector Name
Reviwer/inspector Sipatare:
&.Pr Mafka. m wf ER'-rew /)—"Dift, fwmfN /'ln..Ilw. t'—rf-- .-- �-
s7 --

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
.lames B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Dan Lewis
Dan Lewis
Rt l Box 122
Orrum NC 28369
Farm Number: 78-78
Dear Dan Lewis:
I ffl1.9;VA
'T R
A& 0
C)EHNF1
April 9, 1997 REGO V ED
APR 0 9 19971
FAfET TEViLLE
REG. OFFICE
You are hereby notified that Dan Lewis, in accordance with G.S. 143-215.1OC, must apply for
coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has
thirty (30) dAu to submit the attached application and all supporting documentation. In accordance
with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any
owner or operator who fails to submit an application by the date specified by the
Department SHALL NOT OPERATE the animal waste system after the specified date.
Your application must be returned within thirty (30) days of receipt of this letter. Failure to submit the
application as required may also subject your facility to a civil penalty and other enforcement actions for
each day the facility is operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package. The
signed original application, one copy of the signed application, two copies of a general location map, and
two copies of the Certified Animal Waste Management Plan must be returned to complete the application
package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Permits and Engineering Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any question concerning this letter, please call Mike Lewandowski at [phone]
extension 362 or Ed Buchan with the Fayetteville Regional Office at [phone]
Since ely,
for A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Fayetteville Regional Office (w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycle[/ 100/6 post -consumer paper