830018_INSPECTIONS_20171231

2 14
NORTH CAROLINA
Department of Environmental Quaff

- -- — _ /7
,�-Divisionon of Water Resources
Facifi Numbe ty r 19571 - ® Division of Soil and Water Conservation
_ ;,- ®tither 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 0 Denied Access
Date of Visit: �
Arrival Time: d.'QQ Departure Time: / County ey� ,,O Region: A;�ZO
It
Farm Name: '-rytj�G el % �'iC, rGi" Owner Email:
Owner Name: g �f'1'7� , Phone:
Mailing Address:
Physical Address:
Facility Contact:
I e 6a,
Onsite Representative: h
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: �i'►'Lf f f _
Certification Number: 17479
Certification Number:
Longitude:
Deesign Current
esign Current Design Current
Swine
Capacity Pop.
V4'et Poultry {Capacity Pow p Cattle Gapaeity Pop.
f
Wean to Finish
La er
Dairy Cow
NO
Wean to Feeder
on -Layer
Dairy Calf
Dai Heifer
Feeder to Finish
•.
k
Design CurrenE:
D , 1?,oultCa aci Po
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Caw
_7
Turkeys
Turkey Poults
Other _ *
Other
Other
-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [�NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
0 Yes
❑ No
QPNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
7�
Page I of 3 21412015 Continued

Facili 'Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 5
❑ No NA ❑ NE
❑ No NA ❑ NE
Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[:]No
�} NA ❑ NE
waste management or closure plan?
T
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
W NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
1�NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[:]No
? NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[:]No
QD NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
❑ No
[P NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
NA
0
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
ER NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
P NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
r= 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
❑ No
NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Judge Survey
22. Did the facility fail to install and maintain a rain gauge?
[::]Yes
[:]No
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A ❑ NE
Page 2 of 3
21412011 Continued

Vacili Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,❑ No NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No [� NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No [ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes []No NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Yes ❑ No NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No ® NA ❑ NE
TO
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No NA ❑ NE
Comments (refer to question # , Ezplaiii any=YES answers and/or any additional recommendations or any other comments.
Me drawings�of facility. to,lietter�explain.asitga(use additional pages asrnecessary)
/VP Laocoti QieV'tJ-
/A) dowy ,n 1"r-, /r
/U0 , f�wr%A jo;ej. Pj21rnv4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /a' ,7— 330V
Date: 1b
o
21412015

i ype of visit; IV %.ompuance inspection v vperanon xeview V structure Lvatuauon V i ecnntcat Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 3 ( Arrival Time: P21 002,k. I Departure Time: County: -4 f4 A/UP Region: A:AD
Farm Name: ►yll e G Owner Email:
Owner Name: "r Phone:
Mailing Address:
Physical Address:
Facility Contact: Ivwe (aow 6414 e / _ Title:
N
Onsite Representative:
k
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: a
Certification Number: 17629
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Wean to Feeder
Feeder to Finish
1 lNon-La er I
-exillowurrent
D . �l'oul Ca .aci P,o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Outer
Other
Other
Disc�es and Stream Impacts
1. is any discharge observed from any part of the operation? [:]Yes [& No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Appiication Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[]No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
M NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PQ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Strucre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�t`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T'
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T� 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 F] 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 M 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): h
13. Soil Type(s):tj„ S -'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
n No
�T©`
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
7�
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [-]Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YD No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facg Number: - IT jDate of Inspection:
/
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
M No
[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[M 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
FO No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted.which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question.##) Eiplii i=any,YES answersmud/or any additional recommei
Use drawinis of facility to betteriexplam situations (use additional pages as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes M1 No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
r)tPNo
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes
[pNo
❑ Yes
CP No
[] Yes
[5D No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: -1 ��' �3 4 W
Date:
21412014

i ype or visa: mwt.ompuance inspection v Lyperanon iceview v structure r vantation i ecnmcai Assistance I
Reason for Visit: ®Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 7 N,.
F-Itt County Region:
Farm Name: COW'yk, CW �c 5�S � r Owner Email:
Owner Name: u�.� (`.� Q� GYttC_t Phone:
Mailing Address:
Physical Address:
Facility Contact: �� QL q ,,ti'Co,_o_ I Title:
Onsite Representative: W
u
Certified Operator:
Phone:
Integrator:
Certification Number: j r7 b 2 '
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capac
Design
oul. 7Capacity
V�;
Current
Pop.
_ Design Current
CaWe. Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder 3 210
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
; Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
D : Pouitrv:.Ca aci
P,o
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Pullets
Turkeys
lBeef Feeder
NJ
Boars
I Beef Brood Cow
-
-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes �No ❑NA ❑NE
[] Yes [—]No
❑ Yes [:]No
[PNA ❑NE
In NA ❑ NE
❑ Yes
❑ No
W1 NA
0 NE
❑ Yes
® No
Tf
❑ NA
❑ NE
❑ Yes
�� No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Dumber: - Date of Inspection: o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �Rj No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No nNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
U
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 qNo ❑NA ❑NE
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
E3 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
[P 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
J�j No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[�a No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M 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): COOLS-j,a &7vys I )
Lv
S
13. Soil Type(s): �4 —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes R No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 09 No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ff,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
M 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 W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�3 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [53 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

hacili Number: - Date of Inspection: /o
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 9No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes `'P' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ep No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
� No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 noa-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
[] Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalsrecommendations or:any other comments.
Use drawin s .of faclity to better explain situations(use_ additional pages as nece��
y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ?t° J �-37 t0
Date: 6 1 p r
21412011

FI
I1 ype of visit. y c:ompuance tnspecnon V uperanon Keview U structure r vamanon u i ecnnical Assistance
Reason for Visit: e Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: t5 [xt Departure Time: p tr, County: foTL*-J D
Farm Name: `C�� 4��-C s �l�c _ Owner Email:
Owner Name: Cay#' ; r Let F.'. rXes Xzr Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone:
Region: Pf2o
Integrator: j►M,ttfl-�{YrwIJ
Certification Number: t762gs-
Certification Number:
Location of Farm: Latitude: Longitude:
VA
Designs Current v Design Current Design Current
ultry`"`Capacity -x -Pop. Cattle Capacity Pop.ean
to Finish
La er
D ' Cow
ean to Feeder
3
3 p�%
Non -La er
D Calf
Da' Heifer
!Gilts
eder to Finish
�..rrow
to Weanesign,
Dr. P,onit .. , a aci
Current D Cow
P,o Non-Dairyrrow
rrow to Feeder
to Finish
La ers
Beef Stocker
Beef Feeder
Non -La ers
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 1�No ❑ NA ❑ NE
❑ Yes []No
[—]Yes [:]No
❑ Yes ❑ No
❑ Yes f P No
❑ Yes 1� No
�} NA ❑ NE
NA ❑ NE
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412011 Contdnued

FaciliNumber: 73 -1 T jDate of Inspection: 2 7-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3,0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EP 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
W 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
[1] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
`P No
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1P 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 �^❑,,E�v'idenee of Wind Drift ❑:j Application Outside of Approved Area
12. Crop Type(s): �y47Tf1'��nnL+..hA—csr� �5 «'t'r�l
13. Soil Typc(s): ri
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [� No
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TraAfers
❑ 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
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
21412011 Continued

Facilio Number: jDate of Inspection: 22
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 [5 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 0 No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [P 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 Ep 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 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or;any additional recommendations or. ,,any, her comments
Use drawings of facility to better explain situations (use additional pages as necessary).,^,.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '?/0 ' _7 3 Dd
Date: Z
21412011

type of visit: w uompuance inspection v [operation Review V structure Evaluation U iecnnical Assistance I
Reason for Visit: 40 Routine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: . 2 S Departure Time: @r � County: S'O'TZA.*JTj Region: MO
Farm Name: �-fL/MfC64 ,r-�P.r'p/; S i.[ , Owner Email:
Owner Name: 4 U'w G",L41 d Phone:
Mailing Address:
Physical Address:
Facility Contact: •C,�t.' Title: Phone:
Onsite Representative: t
h
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 1'76 o�U
Certification Number:
Longitude:
Current Degn�Current Design Current
SwineWW��gsign,.
a aci Poet Poult , Ca acitV Po ty P; t7 P P Cattle Capacity Pop.
_x
Wean to Finish La er DairyCow
Wean to Feeder R Non -Laver _ DairyCalf
Feeder to Finish F, Dairy Heifer
Farrow to Wean DesignI urrent Dry Cow
Farrow to Feeder D ; P,oultry Caaci Po Non-Dai
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Caw
..,
= Turkeys L
r
Qther:;* Turkey Poults
Other Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P 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
e. 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
T❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
lrj No
❑ NA
❑ NE
of the State other than from a discharge?
kPage I of 3 21412011 Continued

Faefli Number: - Date of Inspection: IZ
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 I Structure 2 Structure 3 Structure 4 Structure 5 Struc e 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
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 j;}No ❑ NA ❑ NE
maintenance or improvement? `r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1P 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 Wi d Drift ❑ Application Outside of pproved Area
12. Crop Type(s): lkrm 11tok C7?
13. Soil Type(s):�.�1
'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
f9 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
MP 20. Does the facility fail to have all components of the CAWreadily available? if yes, check
❑ Yes
rNo
❑ 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
nNo
❑ 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
1�No
❑ NA
❑ NE
Page 2 of 3
21412011 Contdnued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ONE
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?
0 Yes
�To
❑ 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 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? []Yes � No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes *No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #i) Explain any YES answers and/or any additional recommendations or_ anyJ& vir comments. " r
Ilse drawings of facility to better'explatn_situations (use additional: pages as necessary). x f
❑ Yes [)q No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
Reviewer/Inspector Name: r b AN� l Phone: 9% 4
Reviewer/Inspector Signature: Date: 42,b
Page 3 of 3 2 4/1 II

Type of Visit: 40 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 10 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I J Arrival Time: Departure Time: ! !n CountyLk �J�{�J n Region:
Farm Name: �� f i �, ` 1 q Owner Email: ��
Owner Name: IAJIJ4 aLr LL( Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Phone:
Integrator: fames Jd
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current11
Design
..... .
Current_ .._
. . . .
Design Current
Swine Capacity Pop.
Wet lultrlyCapacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry 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
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
[:]No
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'! ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes '[� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 43 No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance a]ternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [P No ❑ NA
❑ Yes 10 TT No ❑ NA
❑ Yes No ❑ NA
❑ Yes rM No ❑ NA
❑ Yes No ❑ NA
❑ Yes No
❑ Yes No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes t No
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: -19 jDate of Inspection: Will
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ANo ❑ 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. 7
❑ 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:
NZYM
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes r, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o] 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?
0 Yes
No
❑ NA
❑ NE
gec&45 rw.1"
s"k
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date: 3 7 1.
21412011

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 0 Denied Access
Date of Visit: Arrival Time: // : Departure Time: o ' County: D Region: f2jZ0
Farm Name: Gt nn %C-L a I _ C +ve..rd "%cpc . �� C + O mail:
Owner Name: v t co'v ' J-.,o Phone:
Mailing Address:
Physical Address:
Facility Contact: Fes""` Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
p
M
Latitude:
Integrator:—r�1.+OWt/�t�c.LL_
Certification Number:
Certification Number:
Longitude:
La Design Current
SDesign
Current
Design Current
SwinerCapacity Pop;
MCIP0ultry
Capacity
Pop.
Cattle C►apacity Pop.
Weinish
La er
Dai Coeeder
3SZ�
Non -La er
Dai Calf
Finish
-
-- -
Dai Heifer
Wean
Design
Current
Cow
Feeder
D . P,oultr
Ca achy
P,o
Non -Dairy
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Qther
Turke Poults
Other
IiMfWYsm ,�..'i k n:i;YJr9YNilht ',,TA:Y'P
Other
a4.Yn-•_".
Discharges and Stream Imparts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[] Yes � No ❑ NA ❑ NE
[] Yes [:]No [53 NA ❑ NE
[-]Yes [:]No P NA ❑ NE
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 [5D No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

~ Facility Number: -IS 71 jDate 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Frceboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADnlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13_ Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
T®
❑ 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
[0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
[�[ No
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
[p 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
Eig No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design [—]Maps ❑ Lease Agreements ❑Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LiuNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA 0 NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1 No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes No
[:]Yes No
❑ Yes No
❑ Yes 11P No
[:]Yes W No
❑ NA [] NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector 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 [P 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) -
Gad eaw-V^ .
G,0) 4C'L'4 r-3.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:'�rd` Y3?`33co
Date: [ ►1
21412011

\\1
� Division of Water Quality
ri F=Facflityumber 3 Q Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a Routine O Complaint Q Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: O Arrival
Time: n Departure Time: Q �� County: 5 "rLo �D
Farm Name:ywC.'Poel �,.-�P..rr3.� + _ Owner Email:
Owner Name: _�2 iy, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:AJ,—&r0tjL_
`I.
Region: FRO
Certified Operator:
Back-up Operator:
Operator Certification Number: 1 ? !a f
Back-up Certification Number:
Location of Farm: Latitude: E_—I o = 1 ="
Longitude: = o = I = u
Design Current
Design C+urrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
FCLWean to Feeder
S
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish I
❑ Dairy Heifer
❑ Farrow to Wean
Dry poultry,
❑ Dry Cow
❑ Farrow to Feeder
El Layers
ElNon-Dairy
❑ Farrow to Finish
❑Non -La Non -Layers
❑ Beef Stocker
❑Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
[�)NA
❑ NE
❑ Yes
❑ No
[P NA
❑ NE
3NA
❑ NE
❑ Yes
❑ No
❑ Yes
�- o
❑ NA
❑ NE
❑ Yes
['No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — a Date of Inspection [
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA. ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
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
tK 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
[P No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
FMNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
r
El NA El NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Grt5'lm( 6L
) cz, K . w Lkj, 5�
tea—c.
13.
Soil type(s) k—9A 1
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I" No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
l
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
l
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
( No
❑ NA
❑ NE
18_
Is there a lack of properly operating waste application equipment?
❑ Yes
EINo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerlinspector Name 1 — l Phone: 910`1762 3 33C I
Reviewer/inspector Signature: Date: T /O
Page 2 of 3 12128104 Continued

^Facility Number: 3 T Date of Inspection
Required Records & Documents
19. Did the facility fait to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
IRNA
❑ 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
JpNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ipNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
r A
❑ 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
414 No
ElNA
ElNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[P No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
`�No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit ID Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 01-'30 M Departure Time: County: / � b Region: r'`«
Farm Name: m t4e Lr Owner Email:
Owner Name: 1 `-'�'+Qe Phone:
Mailing Address:
Physical Address: J'
Facility Contact: ►�'+� Title: Phone No:
Onsite Representative: r' Integrator:
Certified Operator: 1� Operator Certification Number: / / 420 _
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I ="
Longitude: 0 ° = + = u
-
Swore Populati
66
Design Current
Wet P"ouun: Popular tt#le Capaitty Population
AK5 Cap ty n
❑ Wean to Finish
-y.
❑ Layer
Capa'esic ty onA C
❑ DairyCow
Wean to Feeder
❑ Non -La er
❑ Dairy Calf
Feeder to Finish,.
❑ Farrow to Wean
❑Dai Heifer
El D Cow
Ij eFoult
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ LaVers
El Beef Stocker
❑ Gilts
❑ Non -Layers
Beef Feeder
❑ Boars
❑ Pullets
Beef rood Co
F
,:.
Other•.
❑ Turkeys ,.
❑ Turkey Poults fir:
❑ Other
❑Other
Number istructuMs.
ELI
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �RoNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
RNA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ N E
Page 1 of 3 12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
;a NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V�LNo
❑ 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
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
VjNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IPNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R&No
Lr
❑ NA ❑ NE
[IExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn,
etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of�tAcceptable Window ❑ Evidence of Wind Drift ❑!r Application Outside of Area
12. Crop type(s) �
ppCrop
vt'it"I�Lu{�Q lt%La� s "s
vl
13. Soil type(s) LnS A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(jNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
g,No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�iNo
[I NA ❑ NE
Comments (refer to question g): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: a
Reviewer/Inspector Signature: Date:�7
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U} No ❑ NA ❑ NE
the appropirate box.
ElJ_
WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes No [I NA ❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis El 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 �!JNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No P NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ip No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
(K NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
6 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KiNo
❑ 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
V 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
�bo
❑ 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
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Lo
❑ NA
❑ NE
Additional Comments ind/or Drawings; '
Page 3 of 3 12128104

J
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: Tr-0�Arrival Time: 2= �D i++ Departure Time: 3r 30 ,., County:
Farm Name: .RM914� rP ` 1 Owner Email:
I' tLi� '�h f✓
Owner Name: Phone:
Mailing Address:
Physical Address: rr'' /�
Facility Contact: � KP 7rT► , •fl'lS Title:
k
Onsite Representative:
Certified Operator:
Back-up Operator:
Region:.F2
Phone
yr No:
Integrator: ��Tkt"
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = t = « Longitude: = ° = ` = v
r_
Design Current DesignCtirrent Design C•urreat
Swine _ Capacity Popul n 'Net Poultry Ca tyPopulabonCae Capaci�ty Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -La er `. ❑Dai Calf
❑ Feeder to Finish ❑ Dai Heifer
❑ Farrow to Wean ;' ` *�°
.E j ❑ D Cow
Dry Poultry a
Farrow to Feeder 1049 11413 Non -Dairy
❑ Farrow to Finish ❑ Beef Stocker
❑ Gilts ❑ Beef Feeder
❑ Boars ❑ Beef Brood Co
❑ Other dumber of Structur
MASON
es:
Turke s
p
Discharges & Stream Imacts
1. Is any discharge observed from any part of the operation? ❑ Yes A No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No (p NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [3 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) El Yes El No 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation'? El Yes 6 No El NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes th No El NA ❑ NE
other than from a discharge`?
Page 1 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �& NA ❑ NE
Str tyre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [jO 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 [P 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 'P No ❑ NA ❑ NE
maintenance or improvement?
Waste ARPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I] No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes b No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[F] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
Ft] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Reviewer/Inspector Name I ` " Phone: 7/D Y33 ,3 3CO
Reviewer/Inspector Signature: Date:
Page 2 of 3 12125104 Continued

Facility Number: g Date of Inspection
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 appropirate box. (l WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [P
No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes Q] No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
$ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
$j No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EP 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
E] No
❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ip No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
51 No
❑ NA
❑ NE
Additional,,ComgteatslandlOraDrawtngs. h
i
H,,
Page 3 of 3 12128104

4-s r3
W Division of Water Quality
Facility Number 8 j 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'rime: ( QJv1 Departure Time: t 04'k County:
Farm Name: oI [ e I t Owner Email:
Owner Name: �l I Car'Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
V
Region:_
Latitude: = o = ❑ Longitude: = o = =
Design Current Design Current,.:::
Swine Capacity Population Wet Poultry Capacity Population: Cattle
❑ Wean to Finish
Wean to Feeder Zp 7
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
PLayer
Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
91 NA
El NE
❑ Yes
❑ No
NA
❑ NE
�ffNA
❑ NE
❑ Yes
❑ No
❑ Yes
nNo
❑ NA
❑ NE
❑ Yes
$No
❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
%['No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
RNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® 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
[ANo
❑ 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
ONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ANo
❑ 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
KINo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tKNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
4 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) h
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FP No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
[9,No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
I; No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
liqNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
� No
El NA
El 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):
T
Reviewer/Inspector Name Phone: Q 3
Reviewer/Inspector Signature: Date:
12126104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f=1 No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design [I 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IN No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JEI 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
X3 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JXNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 oq _ jAr�rival Time: Departure Time: p-� County: A Region: r O
Farm Name: M((:Ka ri"sp Owner Email:
Owner Name: r� Phone:
r
Mailing Address:
,s 910 )_80-logo (cell)
Physical Address: t� j
Facility Contact: _ G4l �ebtQ�- Title:
Onsite Representative:
0
Certified Operator:
Back-up Operator:
�/{
Phone No:
Integrator: M U4'p4
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e ❑ ' ❑ " Longitude: ❑ o = ' ❑ "
Design Current Design Current Design Current
Swine Capacity Population MTV Capacity opulallou Cattle Capacity Popu ation
❑ Wean to Finish
La er
❑ Dai Cow
IN Wean to Feeder 10--1 Non-Layer
❑ DairyCalf
i00
❑ Feeder to Finish
❑ Farrow to Wean oultry
Dry, (P",'
ElFarrow to Feeder "v 1 t '
❑ Farrow to Finish ❑ Layers
❑ Gilts ElNon-Layers
❑ Boars El Pullets
❑Turkeys
ther
OTurkey Poults
❑ Other ❑ Other
❑Dai Heifer
ElD Cow
El Non -Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co wl
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [5No ❑ NA ❑ NE
❑ Yes
❑ No
'� NA
❑ NE
❑ Yes
❑ No
EANA
❑ NE
P NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�INo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[r No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
PNA ElNE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
"No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
MNo
❑ 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
PNo
❑ NA ❑ NI,
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
[INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
PNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1P 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 Evidence ofWindDrift ❑ Application Outside
of Area
El
12. Crop type(s) ida t9ra Sf (,Wf 1 Pask e)) C"2 ✓'a" ti%�,Q_'^ '
13.
Soil type(s) P4�XS ` Ra
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
91 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
w� ��� x `
Comments (reefer to question##): Explain any YES answers. and/or any recommendations or any other comments '
Use drawn s o[ facilii . to better explain situations. nse:additional a es as necessa . �. s
g t3 p ( pages g necessary): Rk
6-wd -Fbrrn r e &_ds .
Wel i Pv1a i►^ ''rid M
Reviewer/Inspector Name
�� ' -� Phone:
Reviewer/inspector Signature:
Date:
Page 2 of 3 72128104 Continued

Facility Number: 53— Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J*No [:INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes g] No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
99 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
` 3 No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C9 No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[4 No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[R No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
X 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
V3 No
❑ NA ❑ NE
Page 3 of 3 12128104

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: 7-/ -Q Arrival Time: //Ord Departure Time: ,2� County: Region:
Farm Name: C2Cddll4ZaZ 61111iy,O use_ Owner Email:
Owner Name: ar 'sc . �iyG • Phone:
Ir
Mailing Address:
Physical Address:
Facility Contact: je•&,4 rL~e/d T. C r , _ itle:
Onsite Representative:
Certified Operator: __ �d `J6 id 7 Ca
Back-up Operator:
Phone NoA102 76 - .s_g30
Integrator: /yLl[s-D�. A✓�"O[
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: = o Q
Design
Current
Design Current
Design Current
Swine
Capacity
Population'
'Vet Poultry
❑ La er
Capacity Population
Cattle Capacity Population
❑Dai Cow
❑ Wean to Finish
Wean to Feeder
Z'U
50 ID
❑Non -La er
❑Dai Calf
Feeder to Finish
i'
''"` ❑Dairy Heifer
❑ Farrow to Wean
r.
Dry Poultry
❑ Dry Cow
>.��
❑ Farrow to Feeder
n.
❑ Non -Dairy
❑ Farrow to Finish
; ❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
Other
t ❑ Turke s
*-
❑ Other
❑ TurkeyPoults
❑Other
x3
Number of Structures:
awl
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
%No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,h,`Jgg'
rJ 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 1 of 3
12128104
Continued

7
Facility Number: ,3 — S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall).less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes (M No ❑ NA ❑ NE
Stricture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
v
Designed Freeboard (in):
Observed Freeboard (in): ljlTf r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IM 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 UNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0 No ❑ NA ❑ NE
11. Is there evidence of incorrect 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) IJLI Ga, 7"
13. Soil type(s) �GZ
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes tONo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�No [-I NA ❑NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
�No ❑NA ❑NE
Comments (refer to question #): Explain any YES answers aodlor any recommendations or any otherdcomments r
`Use drawings of facility to better explain situations.,. additional pages as necessary).
A,
Reviewer/Inspector Name _—�%✓�,. f Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )6 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IM No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A 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 [9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [XNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
J9 NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
A NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
C4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fM 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
�0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[2 No
❑ NA
❑ NE
Additional Commentsiandlor Drawings:
12128104

t
Facilitv Number
+
Date of Visit:
Time:
rO Not Operational 0 Below Threshold
® Permitted 0 Certified Q Conditionally Certified
O Registered
Date Last Operated or Above Threshold:
Farm Name: �n+ w�
: C.�►a�� t es s� 42 � _ - c-.
County: c,') 06% F"
Owner Name: .11y
S ar a`n � 1s..w .% EJ U
iG_ LA-y-SA0 ( P/hone No: /y ^ 76 ^ SS3 D
Mailing Address:
b r9' n Lr a
ar
L.auj-�Al. C'._
Facility Contact:
Title:
Phone No:
Onsite Representative:
Certified Operator:
Location of Farm:
Integrator: -c o r r b li' S *tlbS.s Z
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C�4 " Longitude 0
- Design Current
Swine - Ga acity Pope
Design Current
on
Design Current
Cattle Ca achy P,o elation
¢_* . Wean to Feeder
ZJ
❑ La er ❑Dairy
on -Layer i ❑ Non -Dairy
�
❑ Other -
Total Design Capacity
' � �r x�� :ter ..�, , TotaluSSLW
❑ Feeder to Finish
-' ❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
H©Iding Ponds/ Saud Traps
❑ Subsurface Drains Present ❑ Lagoon Area
❑ No Li uid Waste Management S stem
❑ S rav Field Area
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 7
05103101 Continued

Facility Number: ff.3 — Date of Inspection �► - -oY
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pendcd for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19_
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Kas� �..� �l rLs ar �,b - ,3f a `bk a ^�TAG'i�r � • I , . -sue. -_"`,. `��api�f�_
Commentsts{refer to question i Explam anyYE�S+answers,andUor eny recitmmendations orany other comments.
ti
i pages as necessar}} ,
�, ®Field Copy ❑ Final Notes
Used of facr� to better ez fern srtuahonMuse addihonal sa
Reviewer/Inspector Name _
Reviewer/Inspector Signature: Date:
05103101 a ✓ Continued

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (W Routine O Complaint O Follow up O Emergency !Notification O Other ❑ Denied Access
Faciliry Number
Date of N,icit: Time; 0 a
rG Not Operational 0 Below Threshold
® Permitted ® Certified © Conditionaliy Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: — t". Ir h" rl ,G e(_ 1,-5yt County:.
Owner Name: CCQrQ�C _ r Phone No. -qtQ .27-� "5 3 D
Mailing Address: b ,,<< Al. G , X93. 5 .2
Facility Contact. 1� r1 c[; G {` L.!`..�r cl,ecl Title: Phone No:
Onsite Representative: 9deV e- Cei r-rn id, 4 ct Integrator: ':a ri*n it �C
Certified Operator: CGCrx a c-t ieL e,4 Operator Certification Number: 176 1 p
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �' Longitude �` �•
Design Current
Swine Cannrity Pnnnlatinn
11 Wean to Feeder
o
3 OD
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow- to Feeder
Farrow- to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ENon-Dairy
Dairy
❑ Non -Laver
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoo. Area ID Sp., Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is anv discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen�ed, was the conveyance man-made?
b. If discharge is obsen ed, did it reach Water of the State? (If yes. notify DVi'Q)
c. If discharge is observed. what is the estimated flow in eal/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?
Wage Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure
Identifier:
Freeboard (inches):
05IV3101
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
N No
❑ Yes
] No
Structure 6
Continued

Facility Number: j — 8 Date of Inspection 3 !
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes No
❑ Yes P No
❑ Yes Q0 No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[�R No
Waste Application
10. Are there any buffers that need maintenance/improvement? -
❑ Yes
[5 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
MNo
12. Crop type SL'co "et
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[] No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
I5. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment? ❑ Yes [P No
Rea uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q9 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
F-! No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
(A No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
C9 No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-
�Cmen�er5to que°sfzon #1] Ezplam a�YE�ans�wers�r`rtemmen_ dahans or anyrotber�comtnents.
Use drawutgs ofifae.dity�to better ezpla�n sy�gqt,uatxons�{u�seiaddifronayl�g"pages���necessary) ❑Field Copy ❑Final Notes
4— a`(. Co r-C�. ttro (Ile o .
Reviewer/Inspector Name T l:
Reviewer/Inspector Signature: Date:(o44
O5103101 Continued

Facility Number: X,3— g Date of Inspection l
Odor ssu
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes (�], 'No
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No
05103101

Type of Visit ® Compliance Inspection O Operation Review C) Lagoon Evaluation
Reason for Visit *Routine" C)Complaint C)Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: D Time: : t7C7
Facilit.- Number
Not Operational 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified i] Registered Date Last Operated or Above Threshold:
Farm Name: ri Z Count\,: -it-Q fl 6,wei _ F2a
Owner Name: C. a rt,,,.ccA,,r-_S Phone No: 1 u XN- --.5 5.3 0
N3ailinc address: v r' �, r C" 2 s S
Facility Contact: c, Title: Phone No: u
Onsite Representative: r-Q — — Integrator: C4 cem it S „ 7oet, d
Certified Operator: iL3 clu Operator Certification Number: I h._.ls
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �° � Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry . Capacity Population Cattle Ca a'hr Po ulation
® Wean to Feeder ❑ Laver ❑ Dairy
❑ Feeder to Finish 10 Non -Laver ❑Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ goy Total SSLW
Number of Lagoons
Holding Ponds f Solid Traps
Subsurface D
I ❑N
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge orininated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b, if discharge is observed, did it reach Water of the State? (If yes_ notify DWQ)
c. If discharge is observed. what is the estimated flow in eallmin?
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) iess than adequate? ElSpillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 3
Identifier:
Freeboard (inches): )S
05103101
[RNo
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
El Yes
®No
❑ Yes
P No
❑ Yes
[g No
Structure 6
Cvnrinued

Facility Number: — 19 1 Date of Inspection D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ® 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 Qj No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [M No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 53 No
Waste Aonlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes O No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type C,;-,r.� t)hce—t—ok RRrwvUac..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[WNo
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
Q No
15. Does the receiving crop need improvement?
❑ Yes
�3 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
W 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
�9 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ja No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(D No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
S No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes] No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes +❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
�aovr... Gooier
J
Reviewer/Inspector Name
ReviewerllnspectorSignature E(_YK7(� IC, lCr�r...+ ^_ Date: Chq/03
05103101 Continued

Facility Dumber: 8 — Date of Inspection I -V -
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours?
28. is there am- evidence of wind drift during land application? O.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. R'ere any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts. missing or
or broken fan biade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes a No
❑ Yes p No
❑ Yes ® No
❑ )-es [R No
❑ Yes No
❑ Yes No
❑ Yes [SJ No
05103101

V
Type of Visit ID Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit AbRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number irate of Visit: 4Z Time: %4 d
Not erational Below• Threshold
® Permitted ■ Certified [3 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: r �+�' County: 0�
Owner Name: _ ld -.Gar 4z Phone No: .2
Mailing Address: _ L(� f�l�[ a/�/�.. G� C
Facility Contact: L iF+L�e r/ Title: Phone No:
Onsite Representative: Integrator: �.tG�.ld/�1 r. ���•
Certified Operator: /�/ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �• " Longitude '
Design .: Current _
=Cap
acitv:. r Population . '_ Poultry. - _•..
Wean to Feeder
D
3 2e
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
ut i Design Carrel
'Catle=.0.Pion aulati+
- u
❑ Non -saver ❑Non -Dairy
❑ Other
Total Design CspaCjtj 'C
TQtal'SSM :.0
Niimber:of Lagoons_ �t 710 Drains Present ❑ La oon Ares ❑ Spray Feld Area
HoldtagPondsV/.SolidXraps, ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
A
Freeboard (inches):
05103101
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes
C<No
❑ Yes
9No
❑ Yes
XNo
❑ Yes
k�No
Structure b
Continued

Facility Dumber: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?.(ie/ trees, severe erosion,
❑Yes
XNO
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 ves, and the situation poses an
❑ Yes
No
1
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ xcessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type ifSp
13. Do the receiving crops differ with those designated in the Certi (,d Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
Elo
b) Does the facility need a wettable acre determination?
El Yes
[No
c) This facility is pended for a wettable acre determination?ElYeso
15. Does the receiving crop need improvement?
❑ Yes
o
X!,
16. Is there a lack of adequate waste application equipment?
❑ Yes
�No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Ndo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU , checklists, design ma
❑ YestNo
�/ '� ✓
19. Doe 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?
❑ Yes21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑Yes
o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
24. Does facility require a follow-up visit by same agency?
ElYes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
( No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Gaatmeats (refer=tri.questzon #) ,Explain any YE$ aaswers aadlor;any recommendatwns ar anv other comments, -
Use drawtags of facility to better exphttn situations: (nse addtttonal pages as necessary] ❑Field Copy Final Notes
Nv C4,� c-
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 8 O Z
05103101 Continued

Facility Number.
Date of Insix-climi
2AU Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
C7
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 bours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt..
roads, building structure, and/or public
property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s), inoperable shutters, etc-)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
El Yes A No
❑ Yes XNO
❑ Yes XN 0
El Yes XNo
N El Yes 010
❑ Yes No
❑ Yes N 0

Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit \P(Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: - � Time: ` � J
Facility Number
Q Not Operational O Bellow Threshold
Permitted [] Certified © Conditionally Ceerrdriied © Registered% _Date Last Operated or Above/Threshold: .� ... _.
Farm Name: cz.0 Y,Y� 1.. !..�f ��.L....., 17. /-,,,c- ..4re";..5: County:
Owner Name: �.(1 �1L[•+� ..�.�...G!/r�l.� t.��4� Phone No: �f2 �Y.Z-0- . M» ...
Facility Contact: ........ ......................................Title:
Mailing Address:
Onsite Representative:...._Y?.e/.rT.......... _.....................................................
Certified Operator: 4/Q'I
. ....� ...�,tf............................................tea. r'� ----. � .... .......
Location of Farm:
.................... Phone No:... ....._ ............
IUC 2(3s2
_..... 1'1..� ter... f._. ..
Integrator: ...........
5.0.�.. 4' ✓ v Lf ..; W.... _ . _. ._ .
Operator Certification Number: ..... .. ............ . . __ —
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude 0
Deli
.. l� T
Current
DeseQ� {current
&
`>
Deseign .. _ __ _ _^t .
,Sne = ci
Po uiatiou .., Poultry
Ca cr ._'Population . .Cattle . -•_
;:. P__ n.,`>
Wean to Feeder 3 2O
❑ Layer
❑Dairy
❑ Feeder to Finish
10 Non -Layer I ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
❑Other"
Farrow to Finish
-Tow DeSio caps city
Gilts
Boars
Total SSLW
Number o! Dons
Subsurface Drains Present Lagoon Area
I0Spray Field Area
Holding Ponds / Mid Traps
No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes If"o
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 Pilo
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 JOAo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 10"No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Rio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes�'5
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............................................................................................ ....................................
Freeboard (inches): 3
5/00 Continued on back

Facility Number: ,'C;'-? — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate. public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 i . Is there evidence,gf over application? _ ❑ Excessive Ponding ❑ PAN ❑ Hydraulic
❑ Yes qNO
❑ Yes No
❑ Yes No
❑ Yes P O
❑ Yes
A�&Io
❑ Yes g No
❑ Yes fdNo
12. Crop hrPe %'),P.Y`u� I.t r/(C hRr /�/�f, i9r� .`.� nr�rs��� /C ip-At . W1,e-7 _.�>o
13. Do the receiving crops differ with those desig(ia&6d in the Certified Animal Waste Man ment Plan (CAWMP)? El Yes No
14. a) Does the facility lack adequate acreage for land application? El 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 A
r-
N
O
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
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
kTNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
JklNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
' 1 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ YesjNo
24.
Does facility require a follow-up visit by same agency?
❑ Yeso
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
4.4-Yiola4iisor. defcences we hOted d' " ' 'hs'vKjYp ircye to�efi
66-is deice abinit� this visit: ........................ -
,� .-_.,v�,•a ._ .. _.__ _-..: -'- �•. ._. ._ . _ .. .- v..•�. .c_-.__ _ -. _, .w..M .. �-_�.'_t_-a_-..; •r .=. r. _-.._. _ s: .y+ .. r. -_. .. _W`•su-a r. , .....01
/'"`I'�C`rI►t�G�tG.�� hCcS f4l�payt C.�t�s� �
1
Reviewer/Inspector Name w t=-
Reviewer/Inspector Signature: Date: � `�6 3/po

Facility Number. Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below s �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 ' 10
roads, building structure, and/or public property) \\
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yesfi<N'o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �o
32. Do the flush tanks lack a submerged fill pipe or a permanent temporary cover? ❑ Yes A<�No
5/00

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number K'3 - /5
Farm Name: 6j,
On -Site Representative: ll 4
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP: .�/G - py"
Ise yam- /a3y
Annual farm PAN deficit:Aj / pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
_ZOperation pended for wetta a acre
determination based on P2 P3
Irrigation System(s) - circle 4J hard -hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
fi. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (EIigibility failure, Part II, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an i or PE.
E2 Adequate D, and D21D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part lll. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational table in Part III).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
_F9 Lack of acreage which -resulted in over application of wastewater (PAN) on -spray-
field(s) according to farm's-last two years -of irrigation-records.-
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous_ ditches; failure to deduct -required
buffer/setback acreage;-or25% of total acreage identified in CAWMP. includes:: .
small,- irregularly shaped fields - fields less -than 5 acres for -travelers -Dr lessthan
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

4_4
C,� / W"',
Facility Number 73 - 19'
�
Revise Apn120, 1949
*ti�
fart Ill. I-lela oy rleia uetermination
oT tow txemptlon KWe Tor vvA uelerminatlon
TRACT
NUMBER
FIELD
NUMBER' '2
TYPE OF
IRRESTEM
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
��
3r
d-b
3�
.�5
FIELD NUMBER'
- hvdrant. Dull. zone. or point numbers may be used in Dlace of field numbers
deoendino on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBERZ - must be clearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less --than 50%
of its annual PAN as documented in thefarm's previous.two years' (1997 & 1998) of irrigation records,.-cannot.serve as the
sole basis for requiring a WA Determination. -Back-up fields must:be noted in -the comment section and must bemccessible
by irrigation system:
Part IV. Pending WA Determinations
P1 Plan lacks following information:
P2 Plan revision may satisfy-75% rule based.on adequate -overall PAN deficit and -by
adjusting all field acreage to.below'75%.use-rate - -
P3 Other (ie/in process of installing new irrigation system):

4
Facility Number Date of Inspection
Time of Inspection ®24 hr. (hh:mm)
0 Permitted Certified p Conditionally Certified [3 Registered 113 Not Operational Date Last Operated:
Farm Name: ...... QrY�!d L.�LiQ. .�......�kL c'� ...................... County: ........... -.5ca. I� J-----.................
I ...................
Owner Name:....... r..�...."'�.�.��1 a'..... f"►h �I°r L- . Phone No: Z �Jrl�3b
j,, r ......................................................
Facility Contact: ..... 9,Jd. 4.e.--. CSC t' 1. ! C/ Title:....... ? 1�4� �� Phone No: „--••----......
.................................
Mailing Address: ....... 1..f1._� 0..1.....5.1._l d ....F-.1!t'tY?_� �r ...... ...LC�I �.. .....?...I7 K!.0 r1-4 ''�1..4.r..... ��-�S.l.
........
Onsite Representative: Integrator: '
..........r...r..m.. �5....-.....�......_._ . ........ ...
Certified Operator: „„v„�� (..... ... c?' ►!,4� q�° Operator Certification Number :.......................-.............
Location of Farm:
Latitude =• ` 1 « LongitudeF7,1
' :Design ;Current ... - Design Current
,-,7, 75 ";$wine Capacity: Ponul; ion•' Poultry.: Canacitv..Poiouiatinn C
Wean to l=e -der
Feeder to Finish
❑ 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? ❑ Yes 4fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ),7No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes a
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 5
Identifier: A
Freeboard (inches): .............! -3..._.....................................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes *No
seepage, etc.)
3/23/99 Continued on back

Facility Number:g,3 — ] g Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over app4cation? 0 Excfssive Ponding ❑PAN
12. Crop type i � r n, // 1 /il Pr A�1-141 AEA% S / IflOf-01(1 f Q A
13. Do the receiving crops d�fer with those designated in tb(e Certified Ani�rial Waste Management Plan (CA
14. a) Does the facility lark adequate acreage for land application? ��
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17., Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiolp>tignjs:or deficiezicjes were pgte4 ding tl�is:visit;: Yoir will �eeeiye Rio t'upe� ,
corres66fide* ' abaeifthis visit: .................................. .
/i%l ce zorle,e t `�ura' .
�c Gr�ord ( �. c u�%a7• 'C"
' yP
?
❑ Yes O(No
❑ Yes Ye
❑ Yes JNo
❑ Yes XR�o
❑ Yes *No
❑ Yes ONO
❑ Yes ONO
❑ Yes ,-q"1-No
❑ Yes J'No
❑ Yes o
❑ Yes TNo
❑ Yes ,d No
❑ Yes APNo
❑ Yes OKNo
❑ Yes ETNo
❑ Yes �No
❑ Yes )p No
❑ Yes d�No
❑ Yes KNo
❑ Yes #No
❑ Yes kNo
i
Reviewer/Inspector NameR-J
Reviewer/Inspector Signature. __ Date: ,. /T— 6o

Facility Number: W3 — Date of Inspection.
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation? ,,��tt,,
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes kINO
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 91qo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

Facility Number Date of Inspection
Time of Inspection �� O 24 hr. (hh:mm)
[3 Permitted [Certified [3 Conditionally Certified © Registered [3 Not O erational Date Last Operated:
Farm Name: ......... ar41I.Lr4.0.U1... .+ ..l' .-f'%! !---..._-........... County .........ti p .. ....................... ............
Owner Name: .............1I-dGII. r...-..5.� ►'t!1./ :. ........................................... Phone No:..................11. ..-.�.. ..... ............
Facility Contact: .......... AID I.r ......(2dZf1.!r111Kkd. Title:..................................................I..- Phone No ...................................................
1rJ._Aeu ................. �',(�'�./� ��.......
Mailing Address:...........1.0..10 D.�....1 t�1R�'' iti[.�..
Onsite Representative:/I � / Inte rator• S �y[
p wif.....��3.'m/.C.�Es- ............................... g �......�..
Certified Operator: ...............l 16(00 �'i.........7,...........0 --- l!a .0 . .................. Operator Certification Number:....................
Location of Farm:
i........................... .............................. ..................... ................... ...................... .... ............................................................................................................... ............ .....................
1
Latitude Longitude �• �� ��°
- De-si n Current
g _.._ _ Current Delign7` _. :. Design Current
Swine Capacity Po Mahon . 'Point - -
ty ...r_'..:.Caacity _;Po ulation Cattle Capacity Population
Wean to Feeder _QQ ❑ Layer ❑ Dairy
Feeder to Finish Non -Layer
-, ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder = ❑ Other
❑ Farrow to Finish Total:DeSt Ca aclt '
❑ Gilts, Gt
;a . a P Y
❑ soars T6611$SLW- _
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?
h. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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: nn 1 ,
Freeboard(inches): ............ tR..�f.............. .--.--........................................................... .................... .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes Vo
❑ Yes EyNo
❑ Yes o
N
❑ Yes KNo
❑ Yes [KNo
❑ Yes 4 No
❑ Yes kNo
Structure 6
❑ Yes ro
Continued on back

F (cHl r� Number: . Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
jV1 No
(If any of questions 4-6 was answered yes, and the situation poses an
►`
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12. Crop type caim
13. Do the receiving crops differ with those desig ed in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
0 No
16, is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
% No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes P(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes %No
24. Does facility require a follow-up visit by same agency? ❑ Yes [PQ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes allo
�'�io-yioiatignis:or ilefciertcies •were poled• d�rr`ing phis:visit: • Y;oir will-r'eeeipe Rio further - : -
6 resporidencee* abouf this visit _
I One kto 4Uv- 0VVj 6A
A MVW
r Atli
Reviewer/Inspector Name
Reviewer/Inspector Signature. �i��ar_ �Date:
3123/99

Routine O ComDlaint O Follow-uo of
I Facility Number I
Follow-u 3e oh�C..review O Other .�.
Date of inspection (—
Time of Inspection I PTZ 124 hr. (hh:mm)
0 Registered #Certified © Applied for Permit U Permitted jQ Not Operational I Date Last Ope ted:
/� 1 �
FarmName:...l��'�,f-rl.y -�C.�............ County:........4..`'``.............................. ...... _.......
Owner Name:.. �I %C?.A�!... ...5f ....3.,Ma�...................... I .................. Phone No:....... .��..:.��t�..........................................
Facility Contact- '��
y ... �........... ...//.�r. Pr.......... Title:...'1............................. Phone No:........................,.........
Mailing Address: ....G?'4........................�C................ ..........`J Z
z�
Onsite Representative: c-_ /�_ /
p Gr, JX Integrator:...... ..fcr�!.l.....�.........I............. I ................
�E
Certified Operator:. ........................ Operator Certification Number,....................:
' Location of Farm:
Latitude o * =: = « Longitude =* =' "
X ��, � f ,Qy �-��_O�". tiS .Cite ):a.�tk �,ok 5,• -. I NLA'1.11At':; ° �---
's3
$wore Capacity Papvlakon Poultrit y` Caliacrty Populatxin CittleCapacrty I'opuiaiivn
❑ Dairy
❑ Non -Dairy
n Capacity 3�Z ZJ°
SSLW pZA
atal
H F-artdS # ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Ares
of�iagoc►n.S`/� oEdeng# � p r
,Nu�berr � �
❑ No Liquid Waste Management System
G
Wean to Feeder
Z D
❑Layer
'
�
Feeder to Finish
�
Non -Layer
Farrow to Wean
T
����
Farrow to Feeder
� ❑Other
❑Farrow to Finishi©�al��les�g
� .�
❑Gilts
�z -
Boars
eneral
1. Are there any buffers that need maintenance/improvement? ❑Yes to
o
2. Is any discharge observed from any part of the operation? ❑Yes
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 DV4'Q) ❑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
3. Is there evidence of past discharge from any part of the operation? El Yes KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? El Yes ffNo
5. Does any part of the waste management systetp (other than lagoons holding ponds) require ❑Yes JKNo
maintenance/improvement?
b. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes I�No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes ITNo
7/25/97 Continued an back

4i— -y
Facility Number: 3—
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLaQoons.Holding Ponds, Flush Pits, etcJ
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes �No
❑ Yes qNo
Structure 5 Structure 6
Identifier:
Freeboard(ft); ........r....:...................... ............. ................... -...............
10. Is seepage observed from any of the structures? ❑ Yes 9No
I. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes [KNo
12. Do any of the structures need maintenance/improvement? ❑ Yes ,(No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 4 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 06 No
(If in excess of WMP, or runoff a erinJg watefs of ne State, notif DWQ)
15. Crop type r! 4c 4 Car �!�.... �........................... ---------------------------------------- --
16. . .-• - --
16. Do the receiving crops differ with those designated in the Ani al Waste Management Plan (AWMP)? ❑ Yes P�No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes No
18. Does the receiving crop need improvement? ❑ Yes No '
19. Is there a lack of available waste application equipment? ❑ Yes f"No
20. Does facility require a follow-up visit by same agency? ❑ Yes 64 No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes gNo
22. Does record keeping need improvement? ❑ Yes No
For Certified or Permitted Facilities Onjj
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes (�No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
No.violitions•or detcientcie's.wer`noted-during this;visit:- You'will i�eceive•nti further-:
correspondence about this: visit - .' - ::::::.. .:: ::. : _
Comrrrmteirtsy(refer,to question #) ; Exliiain any°YFS,ansr�ers andlvr anyurecoir�nniendations oi" any"a"ot6er_ � �,'",�.
%i&` `� 4. � - nF-.q Nrcrc• tie p, .s;.hSeA &>'3.aF"p'.`b.+'�a ..�,+"S� � �: E (-'.F � G R w`}k.`�'rtv �
Use drawings of racilttv�to better expiaut situations. (use adaitionl pagasvnec�arv) �,�,,����'.....,......w y
[� od� lod k i k ��r �- w e� � Wta.i n 1`c�i ►� e� � D e ra�-�-p�.
7/25197
Reviewer/Inspector NameAW
Reviewer/Inspector Signature: Date:
it 0 r

❑ Division of Soil and Water Conservation ❑ Other Agency
[Division of Water Quality
rRoutine O Complaint O Follow-up of MV2 inspection O Follow-up of D.SWC review O Other `
Date of Inspection Z�2'
Facility Number
Time of Inspection 24 hr. (hh:mm)
RegisteredCertified Applied for Permit ri Permitted 13 Not (? erational Date,Last Operated: ......................
L
Farm Name:........ry"vtGe-IJ.-tlr�.rL.,��'-5.C� County. �CQa.................................................
..............
Owner Name:..l�l.l.t.i �.1a1k1utaie1.. �i1 Cq� � q.. Phone No:......Z:�i�.:.�7r....�,.3.[1........................................
Facility Contact: ... .:..�.....i�.�41 i1 !!!« .......r-i4_.� Title: ... 1��[s?.�4.. . . .......................... Phone No: y �
Mailing Address: D 014 Z �
Onsitc Rc resentative-- Q yy� s inie rater
p.11,_1�:4).57........1..".17.+!5..._e............................................................ g .,f.°....._.................................
Certified Operator,.. z'UL..0 ........4,.,actn_L........................... Operator Certification Number.......................................
Location of Farm:
C
G
Latitude a 0` =" Longitude ' ' "
/+
Desily, li�arreflE
`< gn 9 dvl7esign
13esi Currents 'rent
4# a
Swore � Population. Poultry, Capitcity 'opula on Gaattle ° Capacaty Poptalat on i
.Capacity
Wean to Feeder Sz
, ,
❑Layer ❑Dairy
t 5;
Feeder to Finish
❑Non -Layer ❑ Nan-Dairy
x : El Farrow to Wean
❑ Farrow to Feeder
7
❑Oth
E
❑ Farrow to Finish
Total Des><gn,Capac�ty�: -35$ _2_
❑ Gilts
"
❑Boars
t
SLW�
kTa
x{^'le .y�9jlN °h ESF.r' qq
Number of Lagoons /rtHoldang Ponds - ❑Subsurface Drains Present 110Lagoon Area JOSpray Freld Area
�" - %4��.'sv'ua �"dSJc. wd $ 2. ,.3,R�11' •. �^"" ��1 NT. -- r tlREh�oF'nAi°c"'r�$n '�w:.aLFr.
°ate y�� wy.=; ❑ o Liquid Waste Management System k
General
1. Are there any buffers that need maintenance improvement?
❑ Yes
No
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 obsmed, 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, notifv DWQ)
❑Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
maintenance/improvement?
/6(No
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N'No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
�INo
7/25/97
Continued on back
i

Facility Number: — J g
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes XNO
Structures (Lagoons,Holdine Ponds, Flush Pits, etcJ
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNO
Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ................s j......................................... ............. ................. .............................._..........................................................................
10. Is seepage observed from any of the structures? ❑ 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 need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes �No
Waste Application
14. Is there physical evidence of over application? ❑ Yes y1fNo
(If in excess of WMP, or runoff
++entering waters of the State, notify DWQ�)
15. Crop type .... Q r ?`t......... W a _ 5a� �. a �...J1...Q
er' M�........................ ............... ......... .....................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 'KNo
17, Does the facility have a lack of adequate acreage for land application? ❑ Yes 0
No
18. Does the receiving crop need improvement? ❑ Yes to
o
19. Is there a lack of available waste application equipment? ❑ Yes
20. Does facility require a follow-up visit by same agency? ❑ Yes q
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [� 11110
22. Does record keeping need improvement? ❑ Yes RNo
For Certified or Permitted Facilitit* Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 040
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ANo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
No.violatians•or deficiencies.were.noted-during this.visit - You:will i*ei ive'ito further:
corresPbadehce aboid this`visit:-
Comments,{refer to question #) Explain}anyYES answers and/or anyrmmenttons oe any outer cc►munents.�
x� . , �r ate, x�
Use'.drawjngs of facihty�to 6etter`explain stttiations (iise additistnai pages as necessary} z_ ` y<
���
Sa.r`C e jo -"IojoDIti JS
1�e
CD wk.. Ce (,feo r rou
7/25/97
w
Reviewer/InspectALSt�. yo.
o\ r ame
fi, m - M
Reviewer/Inspector Signature: 0_ Dale: 2.. -Z-9
v V

State of North Carolina
Department of Environment,
Health and Natural Resources •
Fayetteville Regional Office f
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary IDEEHNF;Z
DMSION OF WATER QUALITY
July 25, 1996
Carroll's Foods, Inc.
116 James Street
Laurinburg, NC 28352
SUBJECT: Compliance Inspection
Swine Farms
Hoke, Scotland and Richmond Counties
Dear Sir:
On July 2, 1996, an inspection of several animal operations was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office that these facilities are in compliance
with 15A NCAC 2H, Part .0217, and that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact me at (910) 486-
1541 ext. 325.
Sincerely,
Ricky Revels
Environmental Technician IV
RR/bs
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville N%4-4
FAX [phone]
North Carolina 28301-5043 A An Equal Opportunity Affirmative Action Employer
Voice 910-486-1641 50% recycled/10% post -consumer paper

Facility Number -
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:-7 - z - %
Time: /.moo
General Inform; '
Farm Name: Car ct,a �a� ►..� s County: c.e+kaN d
Owner Name: M o C oor w.; c k,. t Phone No: (9i0) z 7L - 7337
On Site Representative: Integrator. C--VV0ll'5 F�aai s Zwic .
Mailing Address: R,,,y Sox 33
Physical Address/Location: c. Ar-j tz-k. 0A F G So -tr>," - 4
may. � �7 (
Get '�O ic74 - S� STYAi Fi...T
Latitude: 1 1 Lon 'tude: 1 I
Qperation ]Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cairle No. of Animals
❑ Sow O Layer ❑ Dairy
"ur=y 3 5 Zo ❑ Non -Layer ❑ Beef
0 Feedcr
OtherT pe of Livestock Number of Animals:
Ntimber of Lagoons: I (include in the Drawings and Observations she Emboard of each lagoon)
Facilitg TMpggfion:
Lagoon
Is lagoon(s) freeboard less than I foot + 25 year 24 hour storm storage?: Yes ❑ No f�
Is seepage observed from the lagoon?: Yes ❑ No Or
Is erosion observed?: Yes ❑ Noe
Is any discharge observed? Yes ❑ No t�
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes 0
No CIO*'
Does the cover crop need improvement?:
Yes 0
No !r
( UJI the crop; which need improvement)
crop type: _d e�- N-, /.u,� Acreage:
Setback Criteria -
I.s a dwelling located within 200 feet of waste application?
Yes ❑
No Cy"
Is a well located within 100 feet of waste application?
Yes 0
No 13"0"
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
No La�'
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
No M-'
AOI -- January 17,1"6

Maintenance
Does the facility maintenance need improvement? Yes ❑ No M"-
Is there evidence of past discharge from any part of the operation? Yes ❑ No U
Does record Keeping need improvement? Yes ❑ No 3'
Did the facility fail to have a copy of the Animal Waste Management PIan on site? Yes Er No ❑
Explain any Yes answers:
t h s _ -•-i
r �-.-
��.c.; 1 ..:, r!
-� _ o b{� .., -
Gt �+ a Od re � c..c� wry-�•�
1�...w ac�w.w�
�u-4 � I � �y�{;u.., i a {a u
� Dtc<s�1.w 3f, r� �
J —�
Signature:
cc. • Facility Assessment Unit
Dr2mjnz5 or Observation :
LI
AOI — January 17,19%
f
Datez% 94
Use Attachments � f Needed

1o1 @6 '00 0o:00
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 4, 1994
SUBJECT: Compliance Inspection
County
Dear :
On , , an inspection
of your animal operation was performed
by the
Fayetteville Regional Office (MO). Please find enclosed
a copy
of our
Compliance Inspection Report
for your information. It is the
opinion
of this
office that this facility is
in co=pliance With 15A NCAC 2H,
Part .0217, and
that Animal Waste Management
is being properly perforated.
should you have any questions regarding this matter, Feel
free to
contact
me at [phone].
Sincerely,
Enclosure
cc: Facility Compliance Group

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This southern border county was
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county seat of Scotland County, named
so for Scotland in the British Isles from
which many of the early settlers of the
region came.
T

!, 101 00 100 00:00 021 P03
NORTH CAROLINA DEPAR"GMT OF ENVIROHIIIT, WALTH b. NATURAL R88OURCSS
DIVISION OF AL KNRAGSKENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
<ri•PGK�rCISPi<.v:Y�'!e aYl4 .•. •M.y. ".� � O�MOIO�euKe�
�.Oir�.v.-•.a•Mrn:v� i.r.. - ..MafiT J-. x+P.1 �'�i'Wf`KIK%
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o
,...-„_....,..` -_..w
aula 44 . .,
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal_bpera-tion Type:
Horses, cattle, swine, poultry, or sheep
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds With liquid waste
system))
2. Does this facility meet criteria for
Animal Operation $>lOISTRA?ION?
3- Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a C3MTIFIM ANIMAL
WASTE MANAGINOW PLAN?
5_ Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
sells, etc?
EA©
/DDa
,o4r- nerd

101 00 '00 00:00
u Jf
w
ci'I E III
EWA site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2_ Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Hap
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
Q. Does the land application site have a
cover crop in accordance with the
T7 RUW
5. Is animal waste discharged into seaters of
the state by man-made ditch, flushing system,
or other similar am -made devices?
b. Does the animal waste management at this
farm adhere to Best Management Practices
(WW) of the approved S RTIFIGTION?
7. Does animal waste lagoon have sufficient faof'
freeboard? How much? {Approximately
S. Is the general condition of this GAFO facility,
including management and operation,
satisfactory?
LION Ili
Qmments
PaI1901
©©

Site Requires Immediate Attention: No
Facility No. 83 -/ 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
AND AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: J -1 Z) 14 , 1995
Time: 1 0 . 1 (-0
Farm Name/Owner: C a V-t-v) + 'S lt- -_t 11 k Ca rro/n's F o '.� .�
Mailing Address: 47z`) 1-1Q sl-� Rd, L4UO-j v6rlAIC
County: 5 c-fo - d
Integrator: Phone:
On Site Representative: Phone: q/o 2 7 7- O$ 3 S
Physical Address/Location: 51Z /(A/..S .v« Y .o bt sf,- w 1'"C .
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: /000 mob --Feed Number of Animals on Site: ooc)
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 4 39 Z 7" Longitude: 7 9° 2 t. ' 35
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) ®or No Actual Freeboard: 5 Ft. O Inches
Was any seepage observed from the lagoon(s)? Yes o RWas any erosion observed? Yes or(S?
Is adequate land available for spray? es r No Is the cover crop adequate? (V) or No
Crop(s) being utilized: C�oos�/
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? IjPor No
100 Feet from Wells? <ar No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes omd�p
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oko
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o<p If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? ligor No
Additional Comments:
�-�--
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: NO
Facility No. 83 ` / S
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3Il� ± , 1995
Time: 19L: IS
Farm Name/Owner: CQ r m i c k q t j FA r" -s / J D 11 ►.i [a • hn c {,. a�
:Mailing Address:_- / S / o t 01 A Lu"cA-�" 2d , L0.�Yi N b,tyq NC
County: Scc,+ .A
Integrator: Carvoli's �70Ga rc. Phone:-
-On Site Representative: :� a�.N CQ: ►,,..; �t,.�►; I Phone: /9/0) z7co - 7 33 7
Physical Address/Location: _ srz / 3& 9
Type of Operation: Swine rLf Poultry Cattle
Design Capacity: 357,20 Ap-s 2 Number of Animals on Site: _ 3,5zo
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: ,
Circle Yes or No
.Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately i Foot + 7 inches) ®or No Actual Freeboard: 4 Ft. O Inches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosion oWOT
d? Yes or Too
Is adequate land available for spray? �or No Is the cover crop adequate? No
Crop(s) being utilized: Coo SA /
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? lipor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o Ro
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ord9P If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? <5i' br No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

lei 00 'oo m eO 021 P02
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 4, 1994
SUBJECT: Compliance Inspection
5e,off al County
Dear
on , , an inspection of your animal operation was performed
by
the
Fayetteville Regional Office (FRO). Please find enclosed
a copy
of
our
Compliance Inspection Report for your information. It is the
opinion
of
this
office that this facility is in compliance with 15A NCAC 2x,
Part .0217,
and
that Animal Waste Management is being properly performed.
should you have any questions regarding this matter, feel
free to
contact
me at [phone].
Sincerely,
Enclosure
cc: Facility Compliance Group

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Scotland Counth
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This southern border county
was /
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county seat of Scotland County, named
so for Scotland in the British Isles from a•�
which many of the early settlers of the ••� v
region came.
1 "1
///a,,W

101 00 100 00:00 021 P03
WORTH CAROLINA DHPAR7.MW OF EWIROMMT, HSAL.TH & NATURAL RSSOURLBS
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
<.•a.H:x:..o:.x..:*« Aim..
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All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SMION I
Animal deer tion Type:
Horses, cattle, in , poultry, or sheep
1. Does the number and type of animal meet of exceed
the (.0217) criteria? [Cattle (100 head),
horses M), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)]
2. Does this facility meet criteria for
Animal Operation MISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a PMrFIKD ANIMAL
WASTE PULNIAGIPUM PLAN?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
.
ii
I�;i

l 101 00 100 00:00
r-
Field_51te HanacFement
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Hap
Blue Line Stream?
3. Does this facility bane adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
COfRT LnGTl� PLC?
5. Is animal Waste discharged into Waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(Him) of the approved CARTIFICATIOW
7. Does animal waste lagoon have sufficient,
freeboard? How much? (Approximately q-
-T
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
erION �v
Comments
ERELE ..:
N