820020_INSPECTIONS_20171231

NURTH CAROLINA
Department of Environmental Qual

a� (YIs Ln "i
I'vi-sion of Water Reaoureea ...
Facility Number v.J - ' Division of Soil and Water Conservation
+ Agency
Type of Visit:7Roudne
fiance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time; o Departure Time: -�a County: Region: W�
Farm Name: A G M2 --,�-I'y tr- 5 Owner Email:
Owner Name: _ �au4j 1,Ky✓l Phone:
Mailing Address:
Physical Address:
Facility Contact: Cc w4 i,3 jJ Q ow c`G 1 t Title:
Onsite Representative: (
Certified Operator: 6 a. V c' 6, a, t2
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: -f(fY _s -
Certification Number: /0o
Certification Number:
Longitude:
Design Current
:
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Gapaclty
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
'(72
78
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,o.ult ,
Ca aei
P.o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
titherNE
in
I I Turkey Poults
L_LOther
i.ac�rsaunHrnx v+�eew-v.w.wna�.m:-rria.:oan,icrerrw;m+.ia.aww..
I
I 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes D,Aio--_0 NA ❑ NE
❑ Yes [:]No [ rNA ❑ NE
❑ Yes ❑ No [}-5A ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ No Q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [E[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 21412015 Continued

[Facility Number: pate of Inspection: q
Waste Collection & Treatment
. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural frceboard? ❑ Yes
3 '''- ❑ NA ❑ NE
0 N [ ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E2 -<o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[2 -No-
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Ale-
❑ 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
D­tt°
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
210
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C r� - 46,v ,,& -0
13. Soil Type(s): A/ o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L"Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesImo ❑ 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
[Z j,
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[9<6
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If'yes, check the appropriate box below. ❑ Yes E],Kb ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking p Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

[Facility Number: - 2-Z jDate of Inspection: 2
!g (, ) e S't,,,u.7 f l .7,r -17
24: Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑Nd— ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
l.i j N -o ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] 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
Eq -150— ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q`iqo ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑-l'o ❑ 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 [S -N-6 ❑ 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 [2 "" ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes !o ❑ NA ❑ NE
33. Did the Rev iewer/[nspector fail to discuss review/inspection with an on-site representative? ❑ Yes X10 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments -(refer, to question #): Explain any.YES answers and/or any additional recommendations or any other comments.
Vs' cVrawings of facility to better. explain situations (use. additional.pages as necessary).
Cal 1 644
!g (, ) e S't,,,u.7 f l .7,r -17
C)- �.l
Lf S7-�,
ia~ 3nR- (0� sI
Reviewer/Inspector Name: A l
Phone:j.la- Lf ,33- 333
Reviewer/inspector Signature: Date: ti
Page 3 of 3 U 2/4/201

ivision of Water Resources -
Facility Number - O O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0115ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Orlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f� Arrival Time: Departure Time: County: 5A)q Region: Mo
Farm Name: �� 's"W10-G r/y"+ Owner Email:
Owner Name: Dot.,,e /Xq e '1 Phone:
Mailing Address:
Physical Address:
Facility Contact: any'W &e Title:
Onsite Representative:
it
Certified Operator: J>G V -r_ WL! wol
Back-up Operator:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Integrator: +�(.� S
Certification Number: C 4 o ls o l
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
You
Non -L,
Pullets
Poults
Design Current
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Appiication f=ield ❑ Other:
a. Was the conveyance man-made`?
b. Did tite discharge reach waters of the State`? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf'
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes EKo ❑ NA ❑ NE
❑ Yes
❑ No
E 'NA
❑ NE
❑ Yes
❑ No
ETNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes �0
❑ Yes 2�'No
e NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I q0 3 2/4/201 S Continued

Facili Number: V Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No R'1gA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NE
Identifier:
Metals (Cu, Zn, etc.)
❑ Yes
[f No
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Spillway?:
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): 3(.�rfC[�> l'r/rte g co c;;)
.
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
13. Soil Type(s): �p
❑ NA
Observed Freeboard (in): Z
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ffl�o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑,I
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [fNo
❑ NA
❑ NE
acres determination?
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[?'1Q'o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2 -No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L_I o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:��
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes C3 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy
Metals (Cu, Zn, etc.)
❑ Yes
[f No
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ NE
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): 3(.�rfC[�> l'r/rte g co c;;)
.
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
13. Soil Type(s): �p
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ffl�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[f No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[5No
❑ 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 ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [%f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

FacilityNumber: - Date of Inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E ' 10
25.'Ys the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;�d8
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 ja-Mo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CET56-
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA []NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes L .ANo ❑ NA ❑ NE
❑ Yes r;i1qo ❑ NA ❑ NE
[:]Yes [q -No ❑ NA ❑ NE
❑ Yes [--'r—No ❑ NA ❑ NE
❑ Yes EfrNo
❑ Yes �o
❑ Yes [ErNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Gbmments (refer to question #)� Eapla�nran`y. YES a%swers �andlor any additional recommendations or any other comments.
Use d�rawinus ot'faciiity tol!better,�,explain sttustloiiirfusekadditional'Daites.:as:ncccssary).
Reviewer/Inspector Name:
Reviewer/ Inspector Signatu
Page 3 of 3
-16
Phone: C!D`
c
�1
re: Date: Qi-Atc l
2/4 2015

(Type of Visit: QTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance +
Reason for Visit: QAoutine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access I
SIkkDate of Visit: rrival Timer Departure Time: i, O ounty: Region:r�
Farm Name: , loc I "' � Owner Email:
Owner Name: /� of I V &!n Phone:
Mailing Address:
Physical Address:
Facility Contact: Gz'44 &IVL J 4 Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: , �G 5 3
Back-up Operator: Certification Number: z l
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[_la— ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I ILayer
Design
Capacity
IDainy
Current
Pop.
Dcsign Current
Cattle Capacity Pop.
Cow
❑ No
Wean to Feeder
11
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
INon-Layer
I
[],'NIA
i Calf
c. What is the estimated volume that reached waters of the State (gallons)?
Feeder to Finish Od
Farrow to Wean
Dr. P.oult .
Design
Ca aci
C►nrrent
Po
Dairy Heifer
Dry Cow
Non -Dairy
❑ Yes
Farrow to Feeder
Farrow to Finish
❑ NE
Layers
Non -Layers
❑ Yes
❑'No
Beef Stocker
Beef Feeder
❑ NE
Gilts
❑ Yes
Boars
❑ NA
Pullets
Turke s
Turkey Poults
Other
of the State other than from a discharge?
Beef Brood Cow
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[_la— ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ID>A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[],'NIA
❑ 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
[ AA
❑ 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
E�fTlo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: Date of Ins ecdon:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-N ---❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No [3-N7V ❑ NE
Structure 5 Structure 6
❑ Yeso ❑ NA ❑ NE
❑ Yes [O<o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [! No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C;rNo [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 ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes [ eNo ❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No [DNA
❑ 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 Cropp Window Q ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s). tau- ' SC 0 /�`�`�!
0 NE
r
13. Soil Type(s);�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�Vo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ErNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E]"'No
❑ NA
❑ NE
Require_ d_Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
W1,10
❑ 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 0 Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below,
0 Yes
5n`�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
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
2/4/2014 Continued

Facility, Number: O Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . [&4- o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-M ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
12'1\4o
❑ NA
❑ NE
❑ Yes
❑Xo
❑ NA
❑ NE
[:]Yes
[;,No
❑ NA
❑ NE
❑ Yes []'h10 ❑ NA ❑ NE
❑ Yes �2No ❑ NA ❑ NE
❑ Yes [!�'No ❑ NA ❑ NE
❑ Yes Q6/lQo ❑ NA ❑ NE
❑ Yes ;�>o ❑ NA ❑ NE
❑ Yes [:],Aio ❑ NA ❑ NE
Comments (refer.to question:#): Explain any YES answers and/or any additional recommendations or any other comments.
Usexirawiogs,of facility-to'better explain, situations (use additional pages as necessary).
C& C 440, --, 4?4-(
7
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
(9— e�"s P-, 3.7
Phone:
/]ate: {y r
214120)]

915ivislon of Water Quality
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency
Type of Visit: mpliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: t utine Complaint C) Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: 20 il Arrival Time: Departure Time: J County: J a Region:
c
Farm Name: v6c_ �S'Lt�i! ve r; t Owner Email:
Owner Name: DeLu (' ox �L4 Phone:
Mailing Address:
Physical Address:
Facility Contact: O"4 iTitle:
Phone:
Onsite Representative: Integrator: �(
Certified Operator: Lcv - C'. Certification Number:
Back-up Operator:
Location of Farm:
'140- _� � �- - _5� �1
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish p
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
+Layer
Nan -La er
ury rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [E[- o' ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [–]No
CD -ITA— ❑ NE
[aICA' ❑ N E
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 D'C�1A [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q"No ❑ NA ❑ NE
3. Were there any observable adverse impacts•or potential adverse impacts to the waters ❑ Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2011 Continued

Facilf Number: Date of Inspection;
r "
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[qo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[E'�IA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V9 I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
gg- n
❑ 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
E3 -5o'
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[5 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
E Io
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [:�4 ❑ 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 n❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�d WL'•tdC r. r
13. Soil Type(s): N 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PDI�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [5" -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 10 [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
19. 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.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes o
❑ Yes �o
[:]Yes C" No
[-]Yes ffNo
❑ Other:
❑ NA ❑ NE
F] NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
_ Page 2 of 3
, I
❑ Yes [! No ❑ NA ❑ NE
❑ Yes Ef"No [] NA ❑ NE
2/4/2011 Continued

Eacili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eg-Mo ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z1,K`o__ ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NE
❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E7<o ❑ 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
L=J o
❑ 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
ENo
❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Com mentsg(refer to question'#) Eiplain any. YES answers=end/or any n
additioat recommendations or;any:ather comments.
Use:drawings of fii8iliV. 4o iietter'explain'situations (dse;additionalipa�es as necessary).
cGlw(�o,
G-3.7
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
I _� r -0— 2-
f7t
Phone: r
Date:'go41's
214A14

Type of Visit: (3-C—ompliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit. 9-1routine0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access'
A Ilk
Date of Visit: Arrival Time: c +� Departure Time: '0 County: Region': '
Farm Name: D
�:-- S
Owner Email:
Owner Name:
t
Phone:
Mailing Address:
Physical Address: �/�
Facility Contact: ��(�S iyy-60c4A Title:r` Phone:
Onsite Representative: tj Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: �D 7XI
Certification Number: /f
Longitude:
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes L`Sl"o ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No C3-1qA- ❑ 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 o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q N ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued
Design Current
Design Cyurren
Design Current
�
Swine
-:
Cap�apc�ity��C}rPop..'
WetP,oquitry �y, C pakcity� Pnp� y
Cattle @ayp�aeity Pop.
-
f{¢_aiG®lIW1h'J,MFu'-'
Wean to Finish
La er
k
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
E� n
'
.*
Daia Heifer
Farrow to Wean
Dppesign Cu�ryrent
Dry Cow
Farrow to Feeder
Dr, .Poultry ,
Ca'AciP„o-'
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'p—keys
Other
Turkey Poults
Other
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes L`Sl"o ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No C3-1qA- ❑ 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 o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q N ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Faeflity Number: - Date of inspection:
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I� qo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [J'l A�❑ 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 [n -Noma ❑ 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 EfNo ❑ 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
R. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [D -V-5 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EjNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S {
13. Soil Type(s):
a Q G D
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
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
[TNo
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
ZrNo
❑ NA
ONE.
❑ Yes M<_ 1V
❑ Yes ?No
❑ Yes Zo
E-]Yes
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑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 L1Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes VNo
[:]NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Faollity Nhtmber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes GD-Nlo— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C3'N-6 ❑ 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 5Nto ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ED -M ❑ NA C] NE
and report mortality rates that were higher than normal? 1 '
29. At the time of the inspection did the facility pose an odor or air quality concern'? ❑ Yes 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 [3"Po ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
CohfinehO (refer to question #): Explain any YES answers andlor.any additional recommendations or any other .eainments :
Use drawings offAcility'to better explain situations (use additional pages as necessary).
-S�V.y' 6,3- -1 L( 77,
Reviewer/Inspector Name: j) (
Reviewer/Inspector Signature: 11J LM Date:
Page 3 of 3
1

az)
(Type of Visit: (Y'Corn inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: out'ine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: i7 i Arrival Time: ;ti Departure Time: U County: Region: r Rd
Farm Name: C-Toks Mr -,4,n Owner Email:
Owner Name:IC
pkF,S Phone:
Mailing Address:
Physical Address:
Facility Contact: (_U( LS 6 ARU-nC� Title: Phone:
Onsite Representative: t'�:)Ay)E
Certified Operator: is-ro4s D , mC XQ j
Back-up Operator:
Location of Farm:
Latitude:
Integrator: M VOLS N
Certification Number: Wal
Certification Number:
Longitude:
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)?
❑ YesTNo ❑ NA ❑ NE
[:]Yes
Design Current
["NA
Design
Current
Design Current
Swine
Capacity op.
Wet Poultr
C*apacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, i'aultr ;
„ Ca aci
1'o
Non -Dairy
Farrow to Finish
-
Layers
_
BeefStocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other ''
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ YesTNo ❑ NA ❑ NE
[:]Yes
❑No
["NA
❑ NE
[:]Yes
❑No
2/NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [-]Yes ❑ No [:g/NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes F2/) o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 4 o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Faelli Number: ba - O Date of Inspection. 1
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 [Ef NA ❑ NE
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes ❑'No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [3'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 MIK ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [g No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 02'% ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S3No ❑ 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 Ace_eatable 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 [g4o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CEI/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Structure 1
Identifier:
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
lCj
Observed Freeboard (in):
9
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes ❑'No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [3'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 MIK ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [g No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 02'% ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [S3No ❑ 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 Ace_eatable 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 [g4o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CEI/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
y, No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[G"Io
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C244o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CB/No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application 0 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
❑ No
[�JNA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facility Number: a. - QO Date of Ins ection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff�fo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L J44 ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [g' -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:
[]Yes M4o ❑ NA FINE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes [R'<o ❑ NA ❑ NE
❑ Yes ❑,o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2'<o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[R<o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ff"No
❑ NA
❑ NE
Cammcnts' refer to 'ucstion"# Ex latn`an"' 'Y>JS'a'riswcrsiindloe'ati fildtttonal`recaiininendiiti'ons'or:ian :oticr cm`ments
( q ), A.; Y , rr y syr tj m
IYkdrawhigir:'of
"
facilih' tm better ezpla�n�situs�trons�(use pd ittonal pu cs s necessary).
G000 FARm
C '.?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I
Phone: Ck\ s- Las
Date: SjbkjoL
2/4/2011

rti ivision of Water Quality
Facility Number - ® O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: G<ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: tine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:�j f�/� County:
Farm Name: �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: �P(7
Facility Contact: (IjAy�1��(Title: " SCG Phone:
Onsite Representative: 415a6ate-, Integrator: —�
Certified Operator: Certification Number:
Back-up Operator: uL Certification Number: r%
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
ury routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [vKo ❑ NA ❑ NE
[:]Yes
❑No
E24A
❑ NE
❑ Yes
❑ No
2rl�A
❑ NE
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
[RiA
❑ NE
❑ Yes
52<o
❑ NA
❑ NE
[:]Yes
e<o
❑ NA
❑ NE
Page I of 3 2/412011 Continued

FaciIi Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes BTo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 02'110 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
❑ NA
Identifier:'
❑ Yes
Eg o
Spillway?:
❑ NE
[:]Yes
Designed Freeboard (in):
❑ NA
❑ NE
Observed Freeboard (in):
�o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes B<o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes �o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes Io ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [P- ❑ 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 U546 ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [a10 ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [t],"' ❑ 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?
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 E2,11,0
❑ Yes U2<0
❑ Yes 02<o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
021<o
❑ NA
❑ NE
❑ Yes
Eg o
❑ NA
❑ NE
[:]Yes
10
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ ZACE]
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? [:]Yes [:]No NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - Date of inspection;
24.,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 02-iqb ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �To ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA �
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E2'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 E30110 ❑ 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 [1 -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
Mql'o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(1 o
[] NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
I—Ko_
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[jj-Na
❑ NA
❑ NE
Me
mments {refer to question f): Explain any YES answers and/or any additional recommendations or any other comments
drawings of facility`_to:,better explain situations (use additional' pages. as necessary).
GHQ ��,—, G � G�..��Q l�.e��,7�-1.
\j
Reviewer/Inspector Name:
Reviewer/inspector
Page 3 of 3
Phone:
Date:
X412 WJ

$irks 0 / z - z o/0
L ivision of Water Quality
Facility Number,�� 2 i7 0 Division of Soil and Water Conservation
Other Agency
Type of Visit tg<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitoutine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
DateofVisit:475-/D Arrival Time: ; Q Departure'rime: /Z:3o County: Region:
Farm Name: sla Owner Email:
Owner Name: r_ Phone:
Mailing Address:
Physical Address:
Facility Contact: S�Kr r MC_ Title: OBJ&zAo— Phone No:
Onsite Representative: S` o ► PU c.Ke, - Integrator: rc !'d -W N
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: =0 =I
=I[ Longitude: =0=4
o=4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑
Non -Layer
Other
❑ Other _ _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
11:W70
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: U11
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 C317 -o_'0 NA ❑ NE
❑ Yes
❑ No
B<A
❑ NE
❑ Yes
❑ No
E <
❑ NE
B -MA
❑ NE
❑ Yes
❑ No
❑Yes
8-i o
El NA
[I NE
❑ Yes
a1q'o�'
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

w
Facility Number: 8 Z2 0 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stnicture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan'?
❑ Yes 3<",13 NA ❑ NE
❑ Yes 0'No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes l_TNo ❑ NA ❑ NE
❑ Yes Dlvo ❑ NA [IN I,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2'10 [INA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B -f ❑ 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 0-, o ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ETNo ❑ NA ❑ NE
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Leo ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) 3e AVAruj�Slstar� �►2tf� �0 .S
13. Soil type(s) A1.6 _ Z`
14. Do the receiving crops differ from those designated in the CAWMP? ElL� Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ET050o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes/No El NA [:1 NE
17. Does the facility lack adequate acreage for land application? El Yes l.�'No [:1 NA [INE
18. Is there a lack of properly operating waste application equipment? El Yes �No❑ NA ❑ NE
Comme or ii of e ' t
pts {refer to gisestion #t} Fxpiain any YE$ answeirs and/6 any'recommendations Arany athcrromments "`"�nE F�2.
,h; '
Use drawings of facility to better explaln$situationsOL i7(use pdditionAl pages_as necess y}: airy H'
Reviewer/inspector Name, �vq, Phone: %33.330 0
Reviewer/Inspector Signature: Date: �}'-05-70/0
12/28/04 Continued

Facility Number: 82 —Zr� Date of Inspection -45-
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L1'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2<o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I-- lo' El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2rNo
❑ NA
❑ NE
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ 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
[R<o
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9<o
❑ NA
❑ NE
[__1NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o'— ❑ NA
B N
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�� OO
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2 o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2<
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I-- lo' El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
[-}'leo ❑ 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
El9
.,
'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-K ❑ 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
,�
L�lNo❑ NA
[__1NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o'— ❑ NA
B N
❑ NE
12/28/04

r
ivision of Water Quality
Facility Number g2 —I ZD O Division of Soil and Water Conservation
O Other Agency
E
f Visit Compliance Inspection O Operation Review Structure Evaluation O Technical Assistance
n for Visit O Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /D -Z Arrival Time: /o; ori Departure Time: County: �i•1psea./ Region: y/2D
Farm Name: S--�Vkes I' V144kt'i Owner Email:
Owner Name: 54a kGs 114 c, k_ Phone:
Mailing Address:
Physical Address:
Facility Contact: 'r05 s,K°Title: Phone No:
Onsite Representative: 15f0k_Cme ko` Integrator: /1/lu,� Gl RPZI-(-^/
Certified Operator: s'�D dCGS /►'+<L ke k Operator Certification Number: 1672-1
Back-up Operator: S�a�s D'�4 Back-up Certification Number: /7-91G8
Location of Farm: Latitude: = 0 =I = 11
Longitude: =0=6 ❑ {1
Swine
Wean to Finish
)Mean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
.. i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
—I ❑ Non -La er
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
0 urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 0-1
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M< ❑ NA ❑ NE
❑ Yes
❑ No
IA
❑ NE
❑ Yes
❑ No
01gA
❑ NE
3<A
❑ NE
❑ Yes
No
❑ Yes
,❑,
NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: $2 — QZp Date of Inspection /0-29-09
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1er1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement? ❑ Yes ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes ErN. ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes E!<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f5No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 2e_rAY9 9& rh�y//�srrt�cJ .S.►r4l/C9ru.:✓ `D.,$.�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
3'1�o[INA ElNE
I7tvo'❑ NA ❑ NE
No ❑ NA ❑ NE
B o El NA El NE
ISNo ❑ NA ❑ NE
,','"',Y� , !G tir i 1',;,Y,4! w :�w ;stf t ''' "3 .ti t'iapt�"tFi,ty .t I ,ai.t'1 r'' t,f ii'i> i 30 .j rR�'I, '9d uillll
Commcnts'(refer to gitecttonl#) Fxplatn eny YES answ,erts�and a�n1y " mmendat>�ans ar any�other comments.
Use_drawings of facility to�better.4platnuaians(use'additinnal pages as,neFcessatyj
Reviewer/Inspector Name �C — �/ —' s = ' '; Phone•• Jed- Y-33, 3 09
Reviewerllnspector Signature: Date: /0'2— 9- 2100 y
12/28/04 Continued

Facility Number:02 —420 Date of Inspection i°-zv`aq
Reauired Records & Documents
19. Dia the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Io ❑ NA ❑ NE
the appropriate box. ❑ Un TP ❑ Checklists ❑ Desi n ❑ Ma s ❑ Other
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes 10 ❑ NA ❑ NE
12!28/04
g P
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M<011"[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
To ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q 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 [:1 NA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�
B<O ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
2<01 ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0<0-"-[:] 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
ErNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes 10 ❑ NA ❑ NE
12!28/04

fir
.1, ® Dtvtsto I of Water Quality
Fcthty'Number ��
20 f Soil and Water. Consery
OaOther Agency f }
r �
Type of Visit '® Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /Z'ZO~ `�y Arrival Time: //,'/S Departure Time: /Z : O/ County: p Region: A60
or
Farm Name: S� KSS b. lwGeo �2 Owner Email:
Owner Name: kc� Phone:
Mailing Address:
Physical Address: f �,/_
Facility Contact: ST��G-S 10644 �i O cf Title: 67We ✓ Phone No:
Onsite Representative: S� 1�� 5/�GKa'y Integrator: "L kl�Pl�-f .l5 YUZCi/�%
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =0
=i Longitude: =0=E
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder IDNon-La et
Feeder to Finish 1697,T I
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
c: ❑ Boars
Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�] No
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
OfNo
❑ NA
❑ NE
12/28/04 Continued

r'
Facility Number: — ZQ Date of Inspection /z -7o`07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
09",
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [jNo ❑ NA ❑ NE
❑ Yes CgNo [--INA ❑ NE
Structure 5 Structure 6
❑ Yes
q No
[:1NA
❑ NE
ElYes
No
JA
❑ NA
EINE
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 [9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [�fNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J'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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(� No
❑ NA
❑ NE
Comments (refer totquestion #),Explain any..YI;S`anawers andlnr4any recommendations or:any other -.comments
Use drawtngs,of facility to better explain situations (useteddittonalpages as°necessary)i - 1 z'
T av ( L
Reviewer/Inspector Name [�1'C �� J C.� S ---1 Phone:
Reviewer/Inspector Signature: Date:
/Z -20 — ZDD7
Page 2 of '3 12/28/04 Continued

Facility Number: rZ -- ZO 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 [I No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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
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
[;M No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
F2 No
ElNA
[:1NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes[�J
No
❑ NA
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
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
1] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

e Division of Water Quality
Facility Number $ Z mm Division of Soil and Water Conservation
Other Agency
Type of Visit ® Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:��-1cY�'G� Arrival Time: DZ;3S Departure Time: County: 5�+ - Region:
Farm Name: . _ �S�a �e+S D /MG KoU , fi�- V m Owner Email:
Owner Name: ��GK� i. Phone:
Mailing Address:
Physical Address:
Facility Contact: '�lp >- 5 l-kp Title:
Onsite Representative: 54yVt:s m GKa �A
Certified Operator:
Back-up Operator:
Phone No:
Integrator: M Lt 1:1A � S' P 1--0LLj tj
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1 = Longitude: =0=1 =
Design Current
Design CurrentMilli
1111, 111111
Design Current
Swine Capacity Population
Wet Poultry Capacity Papu�Ia�Ion
Cattle Capacity Population
❑ Wean to Finish
JE1 Layer
I I
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer
I I
❑ Dairy Calf
Feeder to Finish 0
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stacker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cow
No
F1 Turke s
E:1 NE
Otilt!
10 Turkey Poults
,Q9
No
❑ Other
JE1 Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[jNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
P No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[X No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
['A No
[:1 NA
El NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
El NA
E:1 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElG Yes
,Q9
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

,l
Facility Number: g7-- 20 Date of Inspection I 11-2- 8`06
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) iess than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes EjNo ❑ NA ❑ NE
Structure 5 Structure 6
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.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
q No
[INA ❑NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
["No
[INA ❑ NE
maintenance or improvement?
{{
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0 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 l0 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) J:�> e_rV_t,kl ci C3,_ Hr,,, _ E Ev—h AXJ0�_ �rr� e� _ SIM a lI 6r4/,J (0; S
13. Soil type(s) 46
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[%No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Lp No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V1 No
❑ NA
❑ NE
Comments {refer to question`#) Explain any,YES answers and/orany recommendatians or any, other comments
;Else drawings of facility to better eiplain stt_uatians:: (use add�honal�pagecaas necessary):'k&
7
Reviewer/Inspector Name I C K j Re_v S
1 Phone:
Reviewer/Inspector Signature:
Date:_-_Z$-_�O (�
Page 2 of 3 12/28/04 Continued

Facility Number: Z — 'Zd I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
N No
[INA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(] No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
odNo
❑ 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
VNI 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
*1 No
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?❑Yes
� No
❑ NA
❑ NE
Additional'Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit 0 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: ' O Departure Time: County:�afi o, Sor, Region:
Farm Name: Inek' Owner Email:
Owner Name: o /lie ko
Phone: 9/0- Sro�/- `1y(e�,.
Mailing Address: -q/ 7s kgmaa wJ!� RteZ_Sa L�md vra NC _2;qis 5--
Physical Address:
Facility Contact: s4A-s 21cko,r Title:
Onsite Representative: SioA.-S Q /y1�/!
Certified Operator: _ Sivlees '0 I7?c leas
Sack -up Operator:
Location of Farm:
Design Current
Swine Capacity Population
1❑ Wean to Finish
❑ Wean to Feeder
[]"Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other -
Phone No: q/o - 385- 2 yfZ L
Integrator: Mvewg
Operator Certification Number: l'7Sb8
Back-up Certification Number:
Latitude: [= o [= 4 [= 11 Longitude: =0=6
0=6 = f1
Design Current
Wet Poultry Capacity Population
❑
Layer
❑ Non -Layer
Dry:Poultry,
❑
Layers
❑ Non -Layers
❑ Pullets
❑
Turkeys
I
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
e
❑ Yes Loo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
El Yes
,D<o
Lrd'No
❑ NA
❑ NE
12/28/04 Continued

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 [1Vo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2lo ❑ 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 214o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0,<0 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
1103 30 S- -2 • ?GO 100
12. Croptype(s) P1��•
�ih a Lc_ +�Yfmvc u. -7rr:�_..,,...,.,....--••--•---------
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
[:]No
❑ NA
CINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
Facility Number: 8a — a 0 Date of Inspection
❑ NA
CINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ No
Waste Collection & Treatment
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O'lYo
❑ 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: _I �
Spillway?: X10
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[1lo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
2'5o
❑ 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 [1Vo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2lo ❑ 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 214o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0,<0 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
1103 30 S- -2 • ?GO 100
12. Croptype(s) P1��•
�ih a Lc_ +�Yfmvc u. -7rr:�_..,,...,.,....--••--•---------
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
[:]No
❑ NA
CINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
CINE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ No
❑ NA
❑ NE
Reviewer/Ins ector Name ` : ky'� f , ` -' ' '' '} "?,?k� Phone: q!o- ygG`Isy/ ex>{ '�'?o
Reviewer/Inspector �4rk QI'An y _. a
'T
Reviewer/Inspector Signature %I2t►r{t ,(jtio.,,E�,� Date: 5- 'y- V57
12/28/04 Continued

-.
Facility Number: —a p Date of Inspection S ti -a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UKo ❑ NA ❑ NE
the appropirate box. ❑ wvf ❑ c>ak ists ❑ De Wr ❑ yars [:1 91Kr ,�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IJ-!Qo El NA El NE
Lf L2-rg->�^7 i-19-72,1
❑,Wasm-Appfteltion ❑ FreebeorE]-W�nnlysi's— ❑ Se44,n4"s ❑ Wars ❑
❑RaiM'SIr ❑ S mg ❑ CTop —Y4 izhd— ❑ I-24MinutIispee4ieris ❑Mon " ❑ Wew"-ecxt-
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal'?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
General Permit`? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
9 -No
❑ NA
❑ NE
❑ Yes
[JNo
❑ NA
❑ NE
❑ Yes
❑-<o
❑ NA
❑ NE
❑ Yes
Eli<
❑ NA
❑ NE
❑ Yes
a<o
❑ NA
❑ NE
❑ Yes
[qNo
❑ NA
❑ NE
❑ Yes O'lrlo ❑ NA ❑ NE
❑ Yes �Tlo ❑ NA ❑ NE
❑ Yes ["No ❑ NA ❑ NE
❑ Yes [']'No ❑ NA ❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
Ll No
❑ NA
❑ NE
Ad id`�tianul Contmen ss stidlor D`raw�ings:
Mr. /nekey aS �ora�r� �c+� Lute($ 64e,,'e.c � Z7vrnCcJ core,.-/
�'S rE ONer5eei/ eroA2 1014Gse ki /✓.�ro�t+> Chic�.`sc� you y�
a" -) C90 cocrs�/ rrvP,
12/28/04

4
Type of Visit • Compliance Inspection p Operation Review O Lagoon Evaluation
Reason for Visit • Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: li' moi' Time: 8' /O
Q Not Operational Q Below Threshold
Mfermitted U ertified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ......... �ipkes........ .1..•.!.C.laX.......... �SlL/.'si..................................... County ......... �+�ktr^��a `'..... ................ .G?....,
Owner Name: .............. . :JZ.eke4 .............. il.. k9e........ ........................................... Phone No:..._ yt o.......� G..Y.. e. y .......................
Mailing Address .............. 111.7.'5 ...............Honet e.1 -j .�.........A-d ...................... ......... �c............... J.31 577 .....................
Facility Contact: ................. t?I.PS............��.kP> ..............Title:................................................................ Phone No:.... g!�....
Onsite Representative: !
.......................Z'.......................................... Integrator: .Ivy.oA
......................t
Certified Operator:............-ljwzs............0....................................
Operator Certification Number:.... fgig................
Location of Farm:
Eg-b"w-ine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' t 44 Longitude ' C 4d
❑ Wean to Feeder
Feeder to Finish 6T7g 60,90
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
;.}"'.' ` Desxgii ;Current' . D'estgn Current
uftiy ;i ..i Ca' aci ! .Population. Cattle ° {, ... - Ca acr Pa elation.
Layer ?« ❑ Dairy
Non -Layer Non -Dairy
IOther i i 4i' 14 i }ii3111 i
j!jToWVes gw' aPaC1 YIN=i.'
4i,TotaISSLW"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes Io
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [TTo
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes Io
❑ Yes B-93-
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M -M
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L do
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: .................................. ......................................._.......................................................................................................................................
Freeboard (inches): 3 ��
12112103 Continued

Facility Number: 8a
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes FIEK
❑ Yes 010
❑ Yes &Fo
❑ Yes <0
❑ Yes [110
❑ Yes [No
❑ Yes B -No
12. Crop type &I' Q . SMA# e-ra"i] DV// 9r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes (ao<o
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
n
❑ Yes 9 No
❑ Yes gNo
❑ Yes M-Pi4
❑ Yes ❑ No
❑ Yes [ -2-O
❑ Yes ❑ No
❑ Yes 0 -No
❑ Yes &Ncr-
❑ Yes gNo
M -held Copy ❑ Final Notes
��; •,+�r�==r=r;;����
���r'.�gf�.i �a.€N>�.i� _,c+»„ r � idi' p 1-•�i� � cE rrs„i.- �,t a G��, t>�''+9,,t.rt.. ��� Reviewer/fim ector Name . In
Reviewer/Inspector Signature: Date:
jr-.79
12112103 Continued

I
Facility Number: B —..70 1 Date of Inspection (�•,�r-uy
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
S -%W
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/. fiP c^hecl lists d�,siga;_maps; etc.)
❑ Yes
P -Ko -
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[moo
❑ Waste Application ❑jeep. ❑ %49fer hffatysis ❑- Boil -Sampling -
�j i&> . g -:)0? /I- /� � �,
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
9 -Ko
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
U.No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
S"
27.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
S -M
28.
Does facility require a follow-up visit by same agency?
❑ Yes
S -No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No--
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (I€ no, skip questions 3)-35)
aNS
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PJPO-
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
21To
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
93 -NT
34. Did the facility fail to calibrate waste application equipment? ❑ Yes M -No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 02Ne-
04toekht-FeFm DGrep-wield Fer+ ❑ I- ❑ inspection Aftertoltft
04-10�erxions ❑ Annual
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_ ,.q `K ;. ':`F 1' 't 'vj1'i € t E .41.:1- ,. S i.{
ddirionalyC�o`iYiiriettts'ancl/or.;Uraurin' s ifwi,. �'� '',b• 1 :r ��([�{4,�{ fli�:llp7rc'�� , .iN�{�,.»,ji4,r,;t({,'„' 4N rj� �I(�I�jj}�Fl,4(�j� i, ;
:e'€MEtnWltx;,E€G F4iYuusl'.15»iifif�k+'€MidtS'!€€h:t4€[p':3.EYl:Y.L':I. sl:} t A�! Vi. �` 1E�1K7 �i al t:.���{'��;�n�{:��:7,'�IiYL'{. 11�'J'I';O11tYkflli�i f1U'rr{:�:! tCp��Fi>�t1�€ip�Nf.L��;'�I��:17itt[3S�{til�s ��'. MU”,
{`� :{I..f».1
7i� 1y{ �,jjr�{j��y3�y.��
"'A
�r
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A,
12112103

Site Requires Immediate Attention: _ N a
Facility No. jag. - 2 0
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: 2-:15 P.M,
Farm Name/Owner:
Mailing Address: 7,83195
Integrator: SCa �o lks Phone: 64 q
On Site Representative: !&-lAgA McKaoA Phone:
Physical Address/Lboation: 1 i t R 100 Co aFP
52 13.15 — 42:f+- a 31 m'/
Type of Operation: Swine,_jtSD Poultry Cattle .-- I we o►. 0ki4vr,-_
Design Capacity: �4,9B -G sl, Number of Animals on Site: (2419
DEM Certification Number: ACE DEM Certification Number: ACN'PNO
Latitude: ° Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm
(approximately 1 Foot + 7 inches) (9 or No Actual Freeboard: 5 Ft. o Inches
Was any seepage observed from the la oon(s)?. Yes ok9 Was any erosion ob rved? Yes or 1�a
Is adequate land available for s ray? TD or No Is the cover crop adequate? or No
Crop(s) being utilized: i' 'f�f R,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling 9(20. or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ori
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ori
Is animal waste discharged into water of the,state by man-made ditch, flushing system,_ or other
similar man-made devices? Yes or(9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
sorav irrieated on specific acreaae with cover crov}? 66 or No
event
el
Inspector Name
cc: Facility Assessment Unit
-Signature
Use Attachments if Needed.

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