820036_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

/r""
IType of Visit: O-Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0-11o_utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,'[`» Departure Time: Q, County: _�5�� Region: �-�
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:r�� l✓�Z Title:Phone:
�- ,
Onsite Representative: 6jA.cl�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: oy
All
Certification Number:
Certification Number:
Longitude:
Swine
Design" Current
Capacity Pop.
Wet Poultry
Design-
Capacity
Current
Pop.
Design Curren
Cattle Capacity .
Popt
Wean to Finish
Layer
airy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
G
Non -La er
airy Calf
-
Design Current
D . P,oul Ca aci P,o
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Oilier.
Other
urke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
C3 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes [31 o ❑ NA ❑ NE
❑ Yes [� ❑ NA D NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 940 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes l�Ko ❑ 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 To ❑ 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 E3 'V o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L7 1Yo ❑ 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 Q N ❑ 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 fo ❑ 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. CropTYPe(s): 'nrf/i11
13. Soil Type(s): p!{JIC
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U 'Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
['lam
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E N
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
'o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�'1�o
❑ 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
�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
1Vo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3 o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFaciHty Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej l o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ Ku ❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Dto [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
l2-110
❑ 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
[3<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
E:rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 l o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

r
i ype of v istt: Ly-c ompitance inspection v uperanon Keview �,j nrructure Evaivanon v r ecnnicat Assistance
Reason for Visit: al routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: << J5 County:-9 �S 611) Region: (
Farm Name: W Ale-O w "d ar m Owner Email:
Owner Name: 'M aj Phone:
Mailing Address:
Physical Address:
Facility Contact: C () f + 15 U C� Title: Phone:
Onsite Representative: i Integrator:
Certified Operator: ZV (_d0_ . A, U"le-^W 0D Certification Number: f UyZ z I�
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder n Q
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
b
Non -La er
DairyCalf
ren Design Curt
Dr. P,oul Ca aci P,o
DairyHeifer
D Cow
Non-Dai ry
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Beef Brood Cow
OtherM I
Turkeys
Turkey Poults
Other Other
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CJNl5- ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
[:]Yes
❑ No
❑ Yes
�o
❑ Yes
E] No
Q-NA ❑ NE
[�NA ❑ NE
D'�]A
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: OX - 37 Date of inspection:
Waste Collection & Treatment_
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ oo
❑ NA
❑ NE
a. Ifyes, is waste level into the structural freeboard?
❑ Yes
[]No
[3-15A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 l f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L FS 1"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
[8No
❑ 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
g No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L4 Ko
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
b
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
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 To ❑ 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): e- � yy (S i'l I
13. Soil Type(s): 113 i ,L�_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3-K-5 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q'I o ❑ NA ❑ NE
16. Did the facility flail to secure and/or operate per the irrigation design or wettable ❑ Yes [-r' ol� ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment".
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.
[j Yes E]-N-o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [tVo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes V� V
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑Yes [J-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o
❑ NA 0 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: I 2. - 7 1 Date of Inspection: E ,,j U1
24. Did the -facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E •No— ❑ NA ❑ NE
a
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [9 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o
❑ Yes E 1Yo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [&-5o ❑ NA ❑ NE
❑ Yes [ff'No ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes
QW6 ❑ NA
❑ NE
❑ Yes
❑'�o ❑ NA
❑ NE
❑ Yes
FtroNo ❑ NA
❑ NE
❑ Yes
[too NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ID - -3, � c077
Reviewer/Inspector Name: b v, Phone: 110 . 3 -33W
Reviewer/Inspector Signature: Date: S
Page 3 of 3 21412015

(Type of Visit: QrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 61iroutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — /Z Arrival Time: IV, D Departure Time: ' / County: Region: {
Farm Name: /art rr�7Tg _�� �_ Owner Email:
Owner Name: L; . s� uy,or. f�CirrsrfK Phone:
Mailing Address:
Physical Address:
Facility Contact:G ; -2,� X Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Integrator: r— < r
Certification Number: 5;z y y G[
Certification Number:
Location of Farm: Latitude: Longitude:
juesign Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
can to Finish
La er
DairyCow
can to Feeder (v QO
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oul .
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
'
Othert
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters` of the State (gallons)? _
d. Does the discharge bypass the waste managementem? (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 [21,No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes C2�No
❑ Yes 1Z_No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

FaciliNumber: - f�, 1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
( No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):c�
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F. No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[yj No
D. NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ja No
D NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes O—No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s)t`d!?L�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [2] No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes SQ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Jallo ❑ 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 Jallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'ED-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facili Number; - Date of Ins ection: G / / 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RLNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D 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 2C No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z 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 ❑ NF
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 [KNo ❑ 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
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Jallo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�J_No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of faciiity to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone:
Date: 6 --/ fl ! 7
21412015
Page 3 of 3

Type of Visit: UCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 / /G Arrival Time: Departure Time: O%v County: sue/=— Region: lid l�
FarmName:OwnerName:
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: 106c_�h ter/ Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:���_
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
p Cignity
Pop.
AM
Wet Poultry Capaci#y Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Curren#
D , P,oui Ca a i P,o ,
Dry Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
. ¢ " -
Turkeys
ether „'
Turkey Poults
Other
Other
liffilm— I.
Discharges and Stream lmpacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of 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
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facility Number: _3 Date of Inspection:
Waste Collection & Treatment
'4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aS_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[a No
❑ NA
❑ NE
(i.e., Iarge trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Eg,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
r,�2No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZjNo
❑ 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
[!g_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ENo ❑ 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):�'riu.L
13. Soil Type(s): 7�fYI��l�x�c
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 .gl No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [-]Yes 29-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes J&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2 .No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes jg_No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes O_No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes EQ 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 12No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
J�j 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
[gNo
❑ 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
DINo
❑ 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
14No
❑ NA
❑ NE
Ej Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
jallo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
El -No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other com eats.
Use drawings of facility to better explain situations (use additional. pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone:
Date: 17 --j l G_
214112015
Page 3 of 3

type of visit: [y-eompttance inspection V vperanon tcevlew V structure Lvatuatton V IecnmCat Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:[County:Region: (?
Farm Name: n �a+' MS -��1c"! Owner Email:
Owner Name: ��i 6 ����'�-'lT�li Phone:
Mailing Address:
Physical Address:
Facility Contact: Title. [jj� �� _ Phone:
Onsite Representative:
Certified Operator: ---
Back-up Operator:
Location of Farm:
Latitude:
Integrator: ,0- n ;5,
Certification Number: 1 % lq
Certification Number:
Longitude:
Swine
Design
Capacity
Current Design Current
Pep. - Wet Poultry Capacity Pop.
Cattle .
Design
Capacity
Current
Pop.
Wean to Finish
Wean to Feeder
Q
U
ILayer
Non -La er
Dairy Cow
Da' Calf
Feeder to Finish
= J ...
R i Design Current
D ': ° P,oul Ca aei Po
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Qther
Other
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
5q No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ N -
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
K No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection:
�r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J]t , No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E4No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;R] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below_ ❑ Yes CO 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
ep
12. Crop Type(s): 1�= 4 / 42CZ r11,3Mr Z
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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes L�J_No ❑ NA ❑ NE
[:]Yes Vj No ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _KNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes EQ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZE-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 54No ❑ NA ❑ NE
❑ Yes 4.No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
[—]Yes fg-No ❑ NA ❑ NE
❑ Yes Ig..No ❑ NA ❑ NE
❑ Yes _
❑ Yes EE�No
❑ Yes 0-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pates as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

r
Facility Number 82 36 Date of Inspection 4-13-99
Time of Inspection 14:00 24 hr. (hh:mm)
0 Permitted ® Certified E3 Conditionally Certified [3 Registered [3 Not O erational Date Last Operated:
Farm Name: AlplacI,arms ............................................................................... .................. County: SAMPSon ........................................... FRO .............
Owner Name: )lexix........................................ HrrAux ...................................................... Phone No: 591-2.40.4 ............................
Facility Contact: lad.B!uxma........................................................ Title: Awmea'Muagiex............................. Phone No:....................--..........---................
MailingAddress: ............................................................................ chatala.Ac ........................................................... 2832,8 ..............
Onsite Representative. ............................................................................ Integrator: ECestagcFarms............................
..........................
Certified Operator: Ede:ard-C............................ Ho eq............................................... Operator Certification Number:17.80Z .............................
Location of Farm:
�?�..na�ttu�asx.side.Q�.S]R,.x�.QQ.a�p��ra�.OAz.�aiile,�.�n�utb.�asx.��.it.�.imterse�xtam.etai:�..S2.t.3.0R2e.�Quxtt.Qi:Hairrellis��1G,.-.iJT.�.iac>�-.. �
[11Y.eKn.............................................................................................................................................................................................................................................................
Latitude 34 • 41 15 u Longitude 7$ • 13 45 u
Design Current
Design
Current
Design Current
Swine Capacity Population
Poultry Capacity
Population Cattle
'Capacity Population
® Wean to Feeder
6080
JE1 Layer
Dairy
❑ Feeder to Finish
JEI Non -Layer
I
I E�]❑
Non -Dairy
El Farrow to Wean
El Farrow to Feeder
❑ Other
Farrow to mis
Total Design Capacity
6,080
1 �
Total SSLW
182,400
Boars
Number of Lagoons 10 Subsurface Drains Present 11n Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
DischarEes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? n/a
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
\ Identifier: .............................
`Freeboard (inches): .............. 24............ ..-. ........
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
23/99
❑ Yes ® No
Continued on back

i
` Faci6. Number: 82-36 1 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
4-13-99
❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenancelimprovement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ❑ No
12. Crop type Coastal Bermuda (Graze) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ® Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
® Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20_
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
IN No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
No . ir7lations;ot deiiciencieswere noted ;during this visit. ' You' will ;receive no furthee , ;
corresoondence about this,visit.
Comments to (refer question #)•' Explain any YES answers'andlor any recommendations or, any, other commmenU.
Use drawingsof facility to better'explain situations (use additional pages as, necessary).
18- Need a copy of farm design material (storage calculations of lagoons) with paperwork on farm site from technical specialist AL
which certified the facility.
19- No irrigation records were on farm site. Farm was noted in 1998 by DSWC and DWQ in regards to setting up irrigation
records for running balance of nitrogen. Mr. Bowens needs to contact his technical specialist in regards to setting up irrigation
records. Notice of Referral will be sent to Division of Water Quality in regards to no irrigation records for farm site. Need to take
waste samples of lagoons every 120 days. Need one soil test a year on all spray fields. Waste Samples of lagoon dated 9-2-97,
4-18-97, and 5-8-98. No soil test results on farm site_
Note: Need to get a copy of farm certification forms on farm site with paperwork from technical specialist which certified the
Reviewer/Inspector Name Scott
Reviewer/Inspector Signature:
Date:
3/23/99

• 1Faci ity Number: 82-36 Date of Inspection 4-13-99
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:.
Note: Need to fill out insect control, odor control, and mortality checklist for permit purposes (General Permit).
Note: Farm has been flagged for WA Determination.
J
3/23/99

Type of Visit: Q'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (D xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /— f Arrival Time: o Departure Time: o County:
Farm Name: 1 ; n Fa0'lrt5 Owner Email:
Owner Name: J6_f �� pw�rt jt7�Crllyy Phone:
Mailing Address:
Physical Address:
Facility Contact: r 7_4 a #ef -: P� , _ Title: (' t)W'n >-r-� Phone:
Region: F�—A O
Onsite Representative: �.� Integrator: %rs�
Certified Operator: ��� Certification Number: %
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current"
Y.
, DesignCnrrent
Design Current
Swine
Gapactty
Po
Wet Poultry
Capac�tyPop 'Cattle
Capacity Pop.
Wean to Finish
EINon-Layer
Layer
Dairy Cow
Wean to Feeder
I I Dairy Calf
Feeder to Finish '
Dai Heifer
Farrow to Wean
esign Current 4_" Cow
Farrow to Feeder
D �P,oultr
Fla s i 4 P6 Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
k Beef Feeder
Boars
Pullets
= Beef Brood Cow
Turke s
Other
Turkey Poultsk�;
Other
w
Other
..
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R] No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
Z No
❑ NA
❑ NE
❑ Yes
(g No
❑ NA
❑ NE
Page I of 3 21412011 Continued

iFacili Number: - Date of Inspection: S —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �C^
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
S No
❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Types): 7_,7,j,0 A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�4 No 0 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?
18. Is there a lack of properly operating waste application equipment?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes [!I No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7®, , 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 to No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? [:]Yes L No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

'acili Number: 4r2= - (� _ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 9LNo ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes K 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 ZLNo ❑ 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 [a No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®, No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
29-No
[DNA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exolain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:jp
Date: s
21412011
Page 3 of 3

r
Type of Visit: ® Compliance Inspection O Operation Review 0 Structure Evaluation O Technical AssistaWew v %
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: egion: j car
Farm Name _ ;, n a L �T� {�/}'r] Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: s Title:
l
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:,1
Certification Number:
Certification Number:
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude:
❑ Yes © No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
0 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 ❑ N ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: bg p - Date of Inspection:
(�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
NVNo
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ
a❑
7. Do any of the structures need maintenance or improvement?
YesrNo""O
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
rONA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E
❑ 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
0 Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
❑ NE
I S. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesVNNoX❑
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Noi'❑ 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 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
Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspecti;�pi[j
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
21412011 Continued

Facili Number: p - Date of inspection: j()1101kK
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ 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 ❑ ❑ 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 N ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes N ❑ 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 ❑ NA ❑ NE
i
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes N�oo NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as n Mss ry).
C'tV
1 Cn
Z"7 /eve /'s A,
( `S7"'"�r"�
�aSj �az3
S14
C l 1,3
34-
.�, /1 3
r 12a//3 ' 1 .776
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��" ►��J f��
Date: 0//3
21412011

Division of Water Quality
Division of Soil and Water Conservation
❑ Other Agency I�I
Facility Number: 090037 _ Facility Status: Active Permit: AWS090037 ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Rgutine County: Bladen Region: Faveltevilig
Date of Visit: 10/1012013 Entry Time: 09:00 AM Exit Time: 09-3Q AM Incident #:
Farm Name: I Owner Email:
Owner: Golden Farms Inc Phone: [phone]
Mailing Address: PO Box 1139 Wallace NC 284661139
Physical Address. 4196 Burney Rd White Oak NC 28399
Facility Status: E Compliant ❑ Not Compliant Integrator: Murphy-Bro n L C
Location of Farm: Latitude: 34°4525" Longitude: 70°44'15"
From White Oak on NC 53, go west 1.3 miles on River Rd (SR 1318).Tum right (NW) on Burney Rd 1.0 miles Turn right (north) on
Tatum and Monroe Lane. Farm entrance on right (east). Signs for # 2529-2531 _
Question Areas.
Dischrge & stream Impacts © Waste Col, Stor, & Treat © Waste Application
Records and Documents Other Issues
Certified Operator: Douglas Stephan Atkins
Secondary OIC(s):
On -Site Representative(s): Name
24 hour contact name Doug Atkins
Operator Certification Number: 985738
Title
Phone:
On -site representative Doug Atkins Phone:
Primary Inspector: Ronnie T Smith Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Phone
Page: 1

Permit: AWS090037 Owner - Facility: Golden Farms Inc Facility Number : 090037
Inspection Date: 1011012013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Inspection Summary:
Crop yield records reviewed
Soil Report 11/27/12
L=OT
Cu & Zn levels wlin range
**due again 2015**
Waste Analysis N
816113 = 1.52
6114/13 = .86
5124113 = 1.37
4/25113 = 1.77
3/18113 = 1.94
2/15113 = 1.69
1122113 = 1.76
**please spray weeds**
irrigation records correspond to rainfall & lagoon records
Sludge Survey done 2012
**due again 2013**
Sludge Survey 50.53%
irrigation calibratin due 2013
—due again 2013***
lagoon bank look good!
Page: 2

Permit: AWS090037 Owner - Facility: Golden Farms Inc Facility Number: 090037
Inspection Date: 10110/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current population
Swine
Q Swine - Farrow to Wean
3,500
3,500
Swine - Feeder to Finish
1,000
1,000
Q Swine - Wean to Feeder
400
400
Total Design Capacity: 4,900
Total SSLW: 1,662,500
Waste Structures
Designed Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 19.50 28.00
Lagoon SINGLETARY
Page: 3

Permit: AWS090037 owner - Facility: Golden Farms Inc Facility Number: 090037
Inspection Date: 1011012013 inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yes No NA NE
1. Is any discharge observed from any part of the operation? ❑ ■ ❑ ❑
Discharge originated at:
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ ■ ❑ ❑
b. Did 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)
❑
■ Cl
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
■ ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the State other than
❑
■ ❑
❑
from a discharge?
Waste Collection, Storage 8, Treatment Yes
No NA
NE
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large trees, severe U ■ U U
erosion, seepage, etc.)?
6, Are there structures on -site that are not properly addressed and/or managed through a waste management ❑ ■ ❑ ❑
or closure plan?
7. Do any of the structures need maintenance or improvement? ❑ ■ Cl ❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, ❑ ■ ❑ ❑
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or Cl ■ ❑ ❑
improvement?
Waste Application Yes No NA NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or ❑ ■ ❑ ❑
improvement?
11. Is there evidence of incorrect application? ❑ ■ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
Page: 4

Permit: AWS090037 Owner - Facility: Golden Farms Inc
Facility Number: 090037
Inspection Date: 10/10/2013 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Waste Application
Yes No NA NE
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑
■
❑
❑
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
■
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑
■
❑
❑
17. Does the facility lack adequate acreage for land application?
❑
■
❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
■
❑
❑
Records and Documents
Yes
No
NA
NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
m
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Page: 5

Permit: AWS090037 Owner - Facility: Golden Farms Inc Facility Number: 090037
Inspection Date: 10110/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No NA NE
Checklists? ❑
Design? ❑
Maps? ❑
Lease Agreements? ❑
Other? ❑
If Other, please specify
21. Does record keeping need improvement? ❑ ■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
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 a rainbreaker on irrigation equipment (NPDES only)?
❑
■ ❑ ❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■ ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the appropriate
❑
■ ❑ ❑
box(es) below:
Failure to complete annual sludge survey
Failure to develop a ROA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
■ ❑ ❑
Page: 6

Permit: AWS090037 Owner - Facility: Golden Farms Inc Facility Number. 090037
Inspection Date. 10/10/2013 Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents Yes No NA NE
27, Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
■
❑
❑
Yes
No
NA
NE
28, Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ ■ ❑ ❑
Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit? (i.e., discharge, ❑ ■ ❑ ❑
freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? ❑ ■ ❑ ❑
If yes, check the appropriate box below.
Application Field
Lagoon / Storage Pond
Other
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
34. Does the facility require a follow-up visit by same agency?
in
Page: 7

I ype of visit: Wc:ompliance inspection V operation fcevtew U structure Evaluation V f ectinicat Assistance
Reason for Visit: 1S"Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: Departure Time: County: Region: rro
Farm Name: /YI
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address: ;i k Sea VPr Lh
Facility Contact: e rfh Title: OeA41 Phone:
Onsite Representative: Integrator,�1-ay e
v
Certified Operator: 51 { 20 k'f h f t%()V Certification Number: - O y y r y
Back-up Operator: _Lj d— e(rjhA Certification Number: 1W,66
Location of Farm:
Latitude:
Longitude:
Swine1
Wean to Finish
D00
esign Current Design Gurrent Design Current
Capacity Pop. :Vet PoWtry Capacity Pop. Cattle Capacity Pap.
Layer Dairy Cow
Wean to Feeder
Non -La er
I
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
i Dai Heifer
Design Current Dry Cow
D . P,oult . Ga aci P._o Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
113eef Brood Cow
Boars
I Pullets
WINOther
Other
Turke s
I Turkey Poults
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
[:)Yes
12 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
U No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued
D

Facility Number: -a, jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
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.)
® No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes 1p No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
N No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ E iide e of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): T
Limbaellrj
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
JZ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
®' No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? I f yes, check the appropriate box below. ❑Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
[:)Sludge Survey
❑ NA ❑ NE
RNA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection::'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CR No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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 M No ❑ NA ❑ NE
❑ Yes fZ No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
0 Yes Q No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
field was I imp... +1l is 1°#/ I T lac .
'�I ;fas,Lojw, is at or99,1 � rnixe w -eG
Gad reards,
Will n f4 call bo*&I -k-hi-S y-ea ,
Reviewer/inspector Name: -JQ61 szh h: f fir
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C110`q33_3T0` ]C`p
Date: �a7 �l �, a 00
2/4/1011

Permit
FR Drab
Lagocin*'Name;
-�gt6gi6illwa�
i::,.:.,-,i',
12
3- =4
5 ..1.6
'7:,,:
Desigh"IF ''ree b
ibJ.1-140136qorcled
in
Observed: *ft­b6dW14R43:,!
Sludge -Depth!'
Liquid Trt- Zones (ftr'V.­.j-1
Ratio S I U d g"e' t6Tr6­a­tM_e
OU61
0 rh e: if;- 0 A 5
of 1.... 01—
Date "ou'Vot
N
Calibeitio6-Diit 3 4 5 .17 1
uesign Flow
m)-,.iil!
iAww'.
-o
I.i!:
Actual Flow'
Design Diam
Actual Diam.1
Soil Test Da
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed;,
WUP
Dead box or incinerator
Lime Applied
ET
MIJ
Weekly Freeboard
Mortality Records
Cu-I
i-�255�--
Z
H
1 in Inspections ✓
Insp.
Check Lists
Storm Water
Needs S
Needs P.:
I!! T j­;!j.
120 min
ea
W Weather Codes
ff 0 1111 RZ rers NTEM M
I
Pull/Field,
7, Fra MMI111111111
j, FITTY'.7.0
MIM
I
Verify PHONE NUMBERS
HONE:NUMBERS ancl'affiliations
Date last W RO FRO or Farm Records
Date Iasi WOr,,, a::fa: Lagoon #
App.' Ha id w': a Top Dike
Stop Pump
Start Pump
. .... t'''.s ;Ii:�`�.!yl; Imo, r`jl1 �;l i!, .. . i Itt;� j If ji L
Conversion101 lb/ac; -! Lil Zn-I 3000= 213 lb/ac
10

I-
qVS BIkS 5! oI;�_
Type of Visit: -Q Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: q, Departure Time: , S' County: �yr� Region: r�Q
Farm Name: I Owner Email: �Q/ �—
Owner Name: L?CIA146111k4 _ Phone:
Mailing Address:
Physical Address: 31(oSea,& dC 1p ajj� I js
Facility Contact: t 1 l/)Ail Title: Q�►1'� �/' _ Phone:
Onsite Representative: Integrator: p(Pf f aq e-
Certified Operator: e I f 1d b ` � TtQ/(jj!n Certification Number: O qq i{ 7
Back-up Operator: L)Qy- %+ei(tkj Certification Number: qcl og6�D
T — -
Location of Farm: Latitude: Longitude:
Design Curren# a Design Current Design Cnrrent
Swine Capes act -Pop Wet Poultry CapacityPo}� Cattle Capacity Pop.
La er - DairyCow
Non -La er
DairyCalf
{
DairyHeifer
U
Des gn Current
Cow
Non -Dairy
Dr. P,onit . Ca aci - P,o .•
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other Other
Finish
Feeder
Finish Wean
o Feeder
Finish
Boars
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes R No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
&a No
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
Page 1 of 3 21412011 Condnued

3�a3�la.
Facili , Number: - Date of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CgNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ 16
Observed Freeboard (in): as
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes � No
❑ NA
❑ NE
(i.e., large trees. severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes 54 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Callo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes 12S 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
' P�-Q
12. Crop Type(s):. MYdl3
13. Soil Type(s): Ta'11L1ha►"IC�Z _
14, Do the receiving= crops differ from those designated in the CAWMP? ❑ Yes CR No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? ❑ Yes rallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ff No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes g No ❑ NA ❑ NE
[—]Yes §�fNo [:]NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes gNo ❑ 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'? I f yes, check the appropriate box below. ❑ Yes EZj�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No ® NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Q, -,�. - -3� 1 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[>—TNo
❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
W No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
2 No
❑ NA
❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[,ZRNA
❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E,:g7No ❑ 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 C�j 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 *[R 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 [allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes FfNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ffNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�� P ice e_ Work 0) 4Terb on, I ayon m I � edvf .9 hvtier. Nwdr *po f �J
f!1'1�-)_(l it'LPf� 4 S cr S�rir�
0, 4q S]vd9
)�, La9ar (s df ,e 'to �7MtPoh + Vold e WI1)117t� u `�o be- clt, cc*
�
> _P rvi�h In eArs � o f caches o= so , � 1Q �(�aokyaz�•
n. WQS �0) (e
�t No I l�rr� ��
a -Of
Be� G.�e rnE
�r
Dr h e 4 e entr rood,
y
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3 21412011

Facility No. _ 3 2 Farm Name _ �`#I ,t% / Date 3+'�3 f a
Permit COC OIC� NPDES (Rainbreaker PLAT Annual Cert }
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Slud a Survey Date
Sludge Depth ft
Liquid Trt. Zone (ft)3
Ratio Sludge to Treatment Volume
01fi �P�f� O'100� `1?'rZVI�'�
Flow
Design-besign
y
---
---
Soil Test Date I ! b 0IP"t, Wettable Acrer0d Y fh' RAIN GAUGE
H Fields WUP U /tE'W 10� Dead box or incinerator
Lime Needed 0— Weekly Fre6board Mortality Records
Lime Applied 1 in Inspections
Cu-I _,.-Zn-I ✓ 120 min Insp.
Needs P -ic Weather Codes
Crop Yield l Transfer Sheets I0-
- Analysis Date7p.=,
r,ie ie��Kfjjj��
111 -
Verify PHONE NUMBERS and affiliations 1�-�VvP�Of�>?Prr�H Ptd}
Date last WUP FRO 101{`11C& Date last WUP at farm la7rp
FRO or Farm RecorgsC �r—
Lagoon # i4
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
App. Hardware
�le Q,� qq �-9.3 7

0V_j
t ype of visit: qq compliance inspection U [operation Keview U nitructure Evaluation U i ectinical Assistance
Reason for Visit: ISkRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r, r Departure Time: ; County:, Region: fi�
Farm Name: Owner Email:
Owner Name: b P ^ Phone:
x
Mailing Address:
Physical Address:
Facility Contact: E1 [ la blek n ell, 1b Title: O �'/��. Phone:
Onsite Representative: naqe— H(']-nq Integrator: N& ja.
- ,V
Certified Operator: l h }�P/'(I Certification Number:
Back-up Operator: �� (l�u Certification Number: INN 6( Ij
Location of Farm:
Latitude:
Longitude:
1
`{+
Design
Current4
4Design
Current
Design Current
Swine
Capacity
Pop -
Wet Poultry
C p ty
Pop.Cattle
Capacity Pop.
Wean to Finish
-
Layer
Dairy Cow
Wean to Feeder
Q
Non -La er
DairyCalf
Feeder to Finish
`_T=
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dry P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts'
Non -La ers
Beef Feeder
Boars
=
Pullets
Beef Brood Cow
Turke s
Other
��'...
Turkey Poults
.
Other
i
Other
,.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes 50 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes '® No ❑ NA ❑ NE
❑ Yes 'R No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N No [DNA ❑ 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 CR No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 5a 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 S1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes El No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Wo ❑ 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 f Crop Window ❑,,� Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): COARL-Ba11 aq- n2ilLee; S02 � 'mo1h 0eJP4
13. Soil Type(s): 2W} L6 S TO
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J'K3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes tK No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes RNo ❑ NA ❑ NE
[:]Yes Q No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes N-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [51-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 2 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
[DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
ED`NA ❑ NE
Page 2 of 3 21412011 Continued

facili ,Number: - X I I Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes R No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 5-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No grNA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes allo ❑ 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
IQ 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
&r 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
R No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�jNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andfor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ro. ,m s
oho f '�ire
S� 1IN TT0/1 /acre i'me Ued- ��� a016 Hh 01h
n,Ped_ fv acre p4 6h0w;hj s,q -nod *0 1
YYeij mQkHomk *vM ald9000t i`P<razls.
min Yvaf9Ch� 01�>'1hJ,
Reviewer/Inspector Name:
ce7p, Ord 'co lvaf.
so[ I *�sf- ind►'caW'_
U
Phone: qIO-q33-330e lffi(/
Reviewer/Inspector Signature: Date: _jV)10_ D
Page 3 of 3 U 21412011

CX"3� tgrPr�e�s
Facility No. Farm Name Date
Permit ✓ COC '✓ OIC� NPDES (Rainbreaker PLAT Annual Cert )
)A117
7
Lagoon
1
2
3
4
5
8
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
3.
Ratio Sludge to Treatment Volume
ICYO
i;i►liY.i!Y&WIFI/./IG7.r inji01v-17 t 1.. 1.' MAULLawiffrf.4'9
- _ • -�©��---
—Des—lign Flow
_-------
v1� O'i S
Soil Test Date !p 3,/c(T/4` Wettable Acres RAIN GAUGE
pH Fields '^WUP Dead box or incinerator
Lime Needed ! `� Weekly Freeboard Mortality Records
Lime Applied ��l�� - 1,5� 1 in Inspections L--1
Cu-1 __ZZn-I 120 min Insp.
Needs P Weather Codes
Cron Yield Transfer Sheets
- . - -
,, ffr
wlMn
Fn .j �INM
N
-
OfAWaIN_•VEr(M
T >r) C;-V-Aof
Pull/Field'
Soil
Crop
Acres
PAN
Wi dow
Max Rate
Max Amt
-
�{
1
I
�
�
I
Tip
aoo
!
ALI
1
4
ALI
�r
'N
I
fl
�
1 i3
I
Nbi?b, 1 -n tl 1 44-- 1047
Verify PHONE NUMBERS and affiliations
Date last WUP FRO J 01(q 1C$ Date last WUP at farm Id rIto
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
rlw �Tv Ir0-•PLo- Q.?rl.�1aL
App. Hardware

I
Type of Visit I%Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Sam S r Region:
A •10
Farm Name: �a��s Owner Email:
Owner Name: G r _T7�ltI�Q Phone:
Mailing Address:
Physical Address:
Facility Contact: Eli-�4kE%I Title: ON419- Phone No: S96-10 9
Onsite Representative:64LyVt21 Integrator: PrP�A,t? _
Certified Operator: F_I rube h 44-eayla Operator Certification Number: @Il yl `t _
IJ
Back-up Operator: r1 Back-up Certification Number: qQ0 $(06
Location of Farm: Latitude: 0 0 Longitude: E= o E:I' a u
{ Design Current, _ Desrgn " Cnrrent Design Current
Srwtne{Capact�ty Pap lsh n '.. �'�'et Pouitry� `Capacity Population Cattle C�apacfty Papuiation
❑ Wean to Finish e, ❑ Layer ❑Dai Cow
RWean to Feeder JE1 Non -Layer I I❑Dai Calf
❑ Feeder to Finish _, ❑ Dairy Heifer
eN
❑Farrow to Wean Dry poultry ❑ D Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑Farrow to Finish �; El Layers ❑Beef Stocker
❑ Non -Layers
EBoars
Gilts ❑ Beef Feeder
s` E] Pullets ❑ Beef Brood Co
-, ❑ Turkeys
Other _ ❑ Turkey Poults
❑ Other )ther Numbero# Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [RNo
❑ Yes E No
❑NA ❑NE
❑NA ❑-`Q
Page I of 3
12128104 Continua

Facility Number: QQ :-
Date of Inspection ol4 hO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes Callo
❑ Yes ❑ No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �t0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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?
5a Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fQ No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WindowEl Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) Coda I B v l pp P Small C= 1 as
13. Soil type(s) AottvAlp T&nahawk
t4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes tRNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes RJ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes N No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:1 Yes JR] No ❑ NA ❑ NE
Comments (refer to question 4): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):.
Reviewer/Inspector Name EI EP Phone: C110 q33 LLWI
Reviewer/Inspector Signature: Date:/ C
Page 2 of 3
M
12128104 Continued
Sef*@LL D ©t D

Facility Number: Ba — Date of Inspection
Rem[ uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fRNo ❑ 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?
23. If selected, did the facility fail to install and maintain rambrcakers 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?
Additional Comments and/or Drawings:
3L. Wh Ti 1f1 --N a)e-- �2nown
Plek l of rVo-jr bat s ph ©" r y (:YfkaJ --soP,
t,
❑ Yes
`Q No
❑ NA
❑ NE
❑ Yes
❑ No
ER NA
❑ NE
❑ Yes
f@ No
❑ NA
❑ NE
❑ Yes
CWNo
❑ NA
❑ NE
❑ Yes
CR"No
❑ NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
[I NE
❑ Yes
]RrNo
❑ NA
❑ NE
❑ Yes
'No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes E;�No ❑ NA ❑ NE
a�. pie do so;I -jer+ bet* e)d o� ye&-
e Vo3t I RAas 'P 4as s�mpze/-
Copej o�Conh►n I f*f 01 -01n
V" 10 0&( -G'rm oj� recoil'r.
No� nbtaj
,, y a s f4 LTde 3, 3 -of
a010 sf ay 'a Q1a )_�d yPd f�
Page 3 of 3 12128104

zi
3 to
Facility No. '/Q e4$-4"Farm Name
Permit / COC
a��q l real,
Date
OIC✓/ NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
_...
0
- -
��LT3�I,�©!1r
MR. Imo!
�11!]'s'Z:�'�
s ►�rl�
� � .��ii1
�1�©1�1��0
�'�'
.�'�:.1�
freeboard (in)
Sludge Survey 1ate
SludgeObserved
De-ptqft)
RUN
Liquid Trt. Zone (ft)
----
Actual
Soil Test Date Wettable Acres 1/ RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed Weekly Freeboard ✓ Mortality Records �—
Lime Applied li�1 in Inspections
Cu-I Zn-I 120 min Insp. T^
Needs P Weather Codes
Crop Yield Transfer Sheets
Waste Analy is • . -
�� . ��
C►1 �� rhr��tF.�•�m�Ci�L�:
�Fi�f7,l�ir7L'i
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
�o�
1
66
o 5-
G
5�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or arm ecords
Lagoon
Top Dike r
Stop Pump
Start Pump r$
Conversion- Cu-I 3000= 108 lblac; Zn-I 3000= 213 Iblac
App. Hardware

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral p Emergency O Other ❑ Denied Access
Date of Visit: J Arrival Time: Departure Time: yo County: sd"Region: PAO
Farm Name: oe_ Owner Email:
Owner Name: ! 1LI' bfY 1r/]e _ Phone: p
Mailing Address: 10s RivQ.'Oi rd P _ C '8X
Physical Address: 1,�,, 1
Facility Contact: Pula&RC/1w Title: _ Ownc - Phone No lagqo-1o5sL�)
Onsite Representative: �+��ll��_ uAellt Integrator: PJ J
Certified Operator: E l i'ZQ be-th PIlI n Operator Certification Number: ojwA a y yt y
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e[= a 0 N Longitude: = 0 0 I 0 u
_:,MDestg�rCurrent
Destgn� t Current
Design C►urrent
°
Capacity` Pop"ulat,on Wet poultry
att3 S Population
Cattle
Capacity Populatian
r
to Finish
❑ La er
❑ Dai Cow
an to Feeder
6020
❑ Non -La er
❑ Dairy Calf
El Feeder to Finish
-
Dairy Heifer
El Farrow to Wean
Dry Poultry
M,
El D Cow
❑ Non -Dairy
❑ Farrow to Feeder"" `
El Farrow to Finish
❑ Layers
Non-LayersEl
❑Beef Stocker
Feeder
❑ Gilts❑Beef
❑Boars
❑Pullets
❑ Beef Brood Co
Other
iA ❑ turkeys
❑Turke Points
a
❑ Other
*'El
Number of Strueturi:s: LLJ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CE�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ETNo
❑ NA
❑ NE
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 8a— 3 Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tgNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CS 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 C,No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Qj No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
&No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
Wo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C&j4dj ' Sty as
13. Soil type(s) rha~�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'kNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
U'No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other commepts.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A6
ReviewerAnspector Name Phone: �X
Reviewer/Inspector Signature: Date:
1212 4 Continued

FacilityNumber: Sa — Date of Inspection $2i—
Required Records & Documents,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5'No ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes RNo' ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 ffNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CRNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
DjNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
QTIo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CR-NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
A�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
J!rNo
❑ 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
RrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EJNo
❑ NA
❑ NE
Comments and/or Drawings:
IS
1 Ton lacre- i"f- 4 li ea� lh S��QF �r i n Zl�
o- -Fern+li)� s f`heels IvM"h cir gali��� -�"h� nifi oy , n dJ
Y
b2 i D,red- )q on fa ' l k p
Ve well ktff `kM 4'90aL pe(oxds,
~i -
S! ✓dGf �L,l rQ 1 b,i a00q SA0KC 47 °10 S) e ' p �7Pa�A66+ vo1 Ale. N© a Aa, n P 4AP
04f I rTHO rf reach - So % - dedJl p e tr o of
Page 3 of 3 12128104

Facility No. g� Farm Name
Permit COC
Po . T e Des!n Current
Al ime_41hJ Date
O C NPDES (Rainbreaker PLAT Annual Cert }
....
0©©0©00
•Im-
--
----
Design - - .. _
--
----
Observed freeboard
7
Width
Actual Width
Soil Test Date .31 sla�ioc
pH Fields
Lime Needed
Lime 4p&ljqj kJ&IT,#C 3b7�Ff
Cu Zn —
Needs P 0_4,0
)a( (6 gKla 61gA
Crop Yield
Wettable Acres
WUP
Weekly Freeboard ✓
Rainfall >1" -%
1 in Inspections
120 min Inspections
Weather Codes s�
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
3113&
- ._ -
103
K
oil
ION 6
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
rTo
Zfts—
aoq
3
A.,
)Ds-
16
ipoo
TO
DOD
C3—lo
DOD
A,
307-
T
DD
M -
1S
Zify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
5a 11�5
"c
Start Pump
491
7
S6
App. Hardware
r N4 �01,le, 0. � 9�
i Irm 14'

TVs � �� (of 131Ox
Type of Visit $a Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit QrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Szkejai Region: ] '�_
Farm Name: Alphe FjoL141 Owner Email:
Owner Name: 6 i6 t�_ _- 4,60r� n� Phone: Sq�DS $
Maihng Address: 105- n -e_ &d ,e_ &L
Physical Address:
Facility Contact: Title:
Onsite Representative:) �dDf!`l h 1�ejj r1 na
Certified Operator: riPtri na
1-1
Phone No:
Integrator: ftn� e— 6mi
Operator Certification Number: Ah4 Will
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [—]o =' =" Longitude: =° [�' =
Dest n Currents ''
Dest nCurrent Design Current
Swine rtyPopulahon�'Cattle
"ty Populahon Wet Poultry
Capact Capacity Population
Wean to Finish❑ Layer
❑ Daia Cow
Wean to Feeder ❑ Non -Layer
❑ Daia Calf
❑ Dai Heifer
Y ❑ D Cow
—
❑ Feeder to Finish
pry Poultry
""*
❑ Farrow to Wean
El Farrow to Feeder
❑ Layers
`" ❑ Non -Layers
+
❑Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars,
P. Pullets ❑
El Beef Brood Co
❑ Turke s
s
-
Other L -
`�... ' ; ❑ Turkey Pou Its
`�`^Number,of
❑ Other
"' ❑Other
Structures:
Discharp," & Stream Impacts
1, Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes.. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2, is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
-KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: $a — 3k Date of Inspection 1f�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rRNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): on
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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? IRYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
U 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
CK No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Cj&'fa
I �ftfh4Q ( J4+p)' SG OS
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
QKNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
29 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
CRNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[KNo
❑ NA ❑ NE
Comments {(refer to question ft, Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerlInspector Name V�- AW 2504AIGIIEL9,� � Phone����
Reviewerfinspector Signature: %xit, Date: (01gfog
Page 2 of 3 U 12128104 Continued

Facility Number: —3 Date of Inspection �Qs
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropirate box.
❑ WUP [I Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 Wo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No UNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N 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
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ 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
C9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M 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
`Q 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
J9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
bury s,P6t3 On 1�10a, wa
a5, Sl vgge, 5u(Ye w j )1 V)&d_-+p be dale jr) aoog
Page 3 of 3 12128104

Facility No. q:)3(
Farm Name
Time In
Owner
Operator
Back-up
COC Circle: General or
Time Out
Integrator
Site Rep
No.
No.
NPDES
Date Oqlos-
Design
Current
Desi n
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
Farrow — Wean
Others
FREEBOARD: Design
Observed
• S� T�
Sludge Survey �d 1 LT-`�P. =3 7
Calibration/GPM
j
Crop Yield
Waste Transfers
Rain Gauge
Rain Breaker
Soil Test 1h*7
Wettable Acres
PLAT
Weekly Freeboard
Daily Rainfall
1-in Inspections
Spray/Freeboard Drop
Weather Codes
120 min Inspections
Waste Analysis:
Date
Nitrogen (N)
Date Nitrogen (N)

Division of Water Quality
Facility Number ga Jb l 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �ZO QArrival Time: -sO Departure Time: County: Region:
Farm Name: 1PI AR_ S Owner Email:
Owner Name: Ell,-a6 ? Bowtn t !crnleict Phone: r%0 7 )—I oS8
Mailing Address: 105 Ftde f QrQP ��n n /JC_ 80^(31
N
Physical Address: c ++ [[
Facility Contact: F'" lr fI•ery-11a'1—Title:
ll
Onsite Representative:
Certified Operator: t I
Back-up Operator:
Phone No: 0/0) 5?D 10.E
Integrator: _' l
Operator Certification Number: +�4�i�
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 4 = Longitude: 0 ° = , [= «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current:.
Cattle Capacity Population_
❑
Dairy Cow
❑
Daia Calf
❑
Daia Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
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?
i
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
ff'NA
❑ NE
❑ Yes
❑ No
EPNA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
Lill,
❑ NA
El NE
12128104 Continued

Facility Number: 3 Date of Inspection Zp
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J='PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No IINA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
tf
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ,yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
S�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
&No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Wo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
Application Outside
❑ Outside of/1A�c_ce�ptable CQro�p Window ❑l Evidence of Wind Drift,,
12. Crop type(s) '--6(.
,(
l❑
LL'rm!JQ V'mo oL 1"a5T� 1, &H, t}f v yf
�o,,f,,Arrea
13. Soil type(s) 1p'l`" s/, l le _ ~7+
, 1
14. Do the receiving crops differ from those designated in the CA%k,MP?
❑ Yes
90
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
D!�NO
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fig No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name f f Phone:
Reviewerllnspector Signature: Date: <(j 20 t7I
IZitaiu4 C.Urr4117ueu

Facility Number: — (a Date of Inspection Zv 0"1
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PSNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IRNo ❑ 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
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
t No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P5No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus toss assessment (PLAT) certification'?
❑ Yes
®No
❑ NA
❑ NE
Otber Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2S No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
W 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
N 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
M No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

I
Type of Visit &�ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Or outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of V Arrival Time: Visit: �j /�s � Q Departure Time: � County: Region: 0
Farm Name: A-L� ei n s= 63e- rrU S _ Owner Email:
Owner Name HE r— f` I A 's. Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title: Phone No:
Onsite Representative:Integrator: �C_ �1
Certified Operator: s Operator Certification Number: y`7�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ 1 =1. Longitude: o = I = u
Design Current
Design; Cttrteni
Design Current
Swine
Capacity Population
Wet Poultry
Capacity Population
C►►attle Capacity Population
❑ an to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
(o fo
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
FAQ
❑ Dairy Heifer
El Farrow to Wean
Dry Pou�l�y^'
- =
��
❑ D Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
x.:
❑ Turkeys
Otteer
❑ Turkey Poults
❑ Other
❑ Other I
Number of Structures:
w z
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
❑ Yes
W No
❑ NA
❑ NE
e. 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
rr',n,No
❑ NA
5
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
K No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
KNo
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

Facility Number: �-3 6 Date of Inspection b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JgNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in): •aLU
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
W 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
19 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
o'
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ej No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
CgNo
❑ 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/ ❑nApplication Outside of Area
12. Crop type(s) C�.�rcS% /�r��^mur�ec L�1��•�
!/CsrSz�r��
�
I�—/�_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ELNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5INo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[] Yes
®,No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA ❑ NE
Comments (refer -to question.#:_ Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better eVlain. situations. (use additionalpagei.as necessary):
Reviewerllnspector Name Phone:
Reviewer/Inspector Signature: Date: O
12128104 Continued

Facility Number: —,j 16, 1 Date of Inspection DG
Re uired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers nnual 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
ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
IC NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
,0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
L,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
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
❑ NA
❑ NE
Additional Comments.indlor Drawings:. '4 y
12128104

Facility -Numbe_r
Division of Water Quality
Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agenev.
Type of Visit 8 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
e
Date of Visit: 6/.?%I Arrival Time: .' -r Departure Time: County: SQ f`+r -so Aj Region:
Farm Name: !!!!&A2i.y e- rrsmJ# Owner Email:
Owner dame: 4c. ALe rr rr q Phone: �7 a To - /o S
Mailing Address: ° S e . '` '� / �et 4 �._ C �L.v �o.e�_ /! -2
Physical Address: —fig_ ! o 1 14.,-k +- lls
Facility Contact:
"Title:
Phone No:
Onsitc Representative: t{}�_ 6- 6- w,!ti� Intehrator: P, e 4or
Q
Certified Operator: Ge.+y --I AJC_t � % Operator Certification Number: .2 Jf A0 1 �f
Back-up Operator:
Location of Farm -
Swine
Back -up Certification Number:
Latitude: ❑ 0 0 t ❑ « Longitude: = ° F--T ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
G Qye3 /ea ❑ Non -Lave[
❑ Wean to Finish
© Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Lavers
❑
Non -!.avers
❑
Pullets
❑
Turke s
❑
Turke Poults
❑
Other
DischaLM & 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
❑ DairyCow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Docs discharge bypass the waste management system:' (If ycs, 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 W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1
Spillway?: ij 14
Designed Freeboard (in): j ct 11
Observed Freeboard (in): pZ G
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 ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ($0 No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [id No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA El 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 R1 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 91 No ❑ NA ❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes FLI No ❑ NA ❑ NE
Comments (refer to question ##): `Ekp1An any YES answers and/or any recommendations'or any other comments.
Use dra of facUi to better explain situations. use additional ' a Bias necessary): wings ty . � (use P g
Reviewer/Inspector Name - d A- /7-j�,.,(L �,:,r,v Phone:
Reviewer/Inspector Signature: 11 Date: oc /.? 7 /61'
_/ - 12128104 Continued

Facility Number: $,2 — 3 Date of Inspection G /?7 /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JX1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [0 Yes ❑ No ❑ NA ❑ NE
2.2. /. s
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [I Annual Certification
ek
❑ Rainfall ❑ Stocking �rop Yield ❑ 120 Minute inspections ® Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[JU 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
9 NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
DO NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[@ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CE 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
$fl 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
�fl No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:'
PIea.a T+a U.ss 4% ro+-..s 4% rig .�L� b•�
V ttr �crY��.�, i KCSC JCnLa V1G1 w Gt r_ t�KwU '-O Vr y.
l L x1'.0 - Ra:,.. S� it - m�•.i-�.�.� �wsip-.
J.. x 0Aj �<VG.1 a�� r'MA Cz`� t.aGt- ,e- �c:r.q i>< cP}-g rio'�- o+^
f w 0 tr e- •C-p r V—' 1
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time: Dv
Facilin- Number a� .�
lot O erational Q Below Threshold
Permitted Op Certified 0 Conditionally Certified 0 Reagistered Date Last Operated or Above Threshold:
Farm Dame: _�/Ji.v l J"G rdos.J Count-: s 1 i2a
Owner Name: �����.+ r n Phone No:
8l2ilinr "address: ��S � ve (Sr��sc Oc�d
Facility Contact:
Title:
Onsite Representative: '&2C l z At- , ;0%x
Certified Operator: L35,� �v /�Gtrrn g
Location of Farm:
Phone No:
Integrator: 'rC-s;�011�-r�a_
Operator Certification Number:
IT Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' L� . Longitude ' • 0
Design Current
Swine rnnarits' Pnnnlatinn
Wean to Feeder
D o
80
❑ Feeder to Finish
❑ Farrow to Wean
{
❑ farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca adty Population
❑ Laver ❑ Dairy
❑ Non -Lave: ❑ Non-Dain,
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area JE3 Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is anv discharge observed from any" par of the operation?
Discbp-rge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if dischar_e is observed. was the conveyance man-made?
b. If discharg: is obsen-ed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is obsen^ed. what is the estimated flow in t=_al/min?
d. Does discharge bypass a lagoon system? (if yes, notifi, DWQ)
?" Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection g Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes [:@ No
❑ Yes ❑ No
❑ Yes
❑ No
N/jw
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
® No
❑ Yes Qallo
Structure 6
05103101 Continued

Facility Number: Qa — 36
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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes R] No
❑ Yes Q No
❑ Yes Q No
❑ Yes ® No
❑ Yes [11 No
NVaste Ayolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive
❑I PAN ❑ Hydraulic Overload
❑Yes
No
12.
/Ponding
Crop type
13"
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
Q No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
I S.
Does the receiving crop need improvement?
❑ Yes
5f No
16.
is there a lack of adequate waste application equipment?
❑ Yes
[)U No
Required Records & Documents
17,
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
® Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ "P. checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
❑ Yes
R1 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AR'MP?
❑ Yes
® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refeuta;questton #). Ez !aiwanrecommendaticinsvr any oilter;:comments. - -
e.
Use drawings of facil to:better explatta situations (use addrttonni pagss;as necessary):aOSec
Field Cotes ❑Final N
Ncwl,t spQL.�gcae_ -0%,—\cVa w�1t , ,.�pr�.V C_ -F \,-, a
M'. Hcrr;�� �� �ak� wa.�i-_ SK;,, plcs rc��lGr�•t.
�5c- pjea.c. Scc_" c.C0L C"4- AG -cc � COr
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �� d
05103101 V Continued

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ORoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: Time:
Faciliny Number
Not Operational 0 Below Threshold
® Permitted Certified 0 Conditionally Certified [] Registered Date Last Operated or above Threshold:
Farm Name: Ala 14B. F4,-Pdls _ County: e
Owner Name: r t Phone No: 0
Mailing Address: ve- ��1,'alc�e_ �t� C%117zti A/C, -?53,'a
Facility Contact:
Title:
Onsite Representative: ��T['y rr�eTN7na
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification number:
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude ' •
Design Current
Swine ranarity Pnnniatinn
Wean to Feeder
1 0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farroxv to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I I❑ Dairy
❑ Non -Laver I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drain
Holding Ponds / Solid Traps ❑ No Liquid Waste
Discharges S Stream Impacts
1. Is any discharge observed from anti• part of the operation?
Discharge originated at: ❑ Laaoon ❑ Sprav Field ❑ Other
a. If discharge is obsen•ed, was the conveyance man-made.)
b. If discharge is obsen-ed, did it reach Water of the State' (If ties. nodA- DWQ)
c. If discharge is observed, what is the estimated flow in Palimin?
d. Does discharge bypass a lagoon system? (If yes, notifi, DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there an,,- adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Stricture 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
® No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
JUNo
❑ Yes
W1 No
❑ Yes
Z No
Structure 6
Continued

Facility Number: ,Z — (p
Date of Inspection
5. .Are there any immediate threats to the integF-ity 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 and- of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
❑ Yes ® No
❑ Yes E No
❑ Yes ® No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
VVacte Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes W) No
11. Is there evidence of over application? f❑ Excessive Ponding ❑ PAN El Hydraulic Overload ❑Yes ®No
12_ Crop type ST�U t•l UdGt _ 2% , , _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA ANP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a %-enable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ®No
13. Does the receivin,g crop need improvement? ❑ Yes ®No
16. Is there a lack of adequate waste application equipment? ❑ Yes N No
Required
Records &_Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
BNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W`UP, checklists. design. maps. etc.)
❑ Yes
EK No
19.
Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with anv applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facilin' fail to have a actively certified operator in charge?
❑ Yes
]M No
22.
Fail to notifi- regional DWQ of emerg:nc}- sitrations as required by General Permit?
(ie" discharge. freeboard problems. over application)
❑Yes
® No
1-3,
Did Reviewerllnspector fail to discuss reviewiinspecrion with on -site representative?
❑ Yes
® No
24.
Does facility require a follow --up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments (refer to question ft Explaza any YE5 answers and/or:any.retotumetielatzags or -
Use drawings of facility to better explain situations. (use addttiona! pages as necessary) ❑ Field Copy ❑ Final Notes
Reviewer/Ins ector Name
p :-i.r+-= ,., . $xxj'�c3�rC xx.x�„`t'�'�� ,,- 'o...•_a •_x.= ra:z..t ..Y .-..a+;.�Y.yesi:r ...w.._ .a-.-
Reviewer/Inspector Signature: Date:
05/03101 U Condnued

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: 4z Time: 1.: 4�
rO hot O erational Q Below Threshold
Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: / County: s�,►�.05z�.-�
'�.
Owner Name: _ eQ /✓A / Phone No: 7O — %a-s- _
Mailing Address:
Facility Contact: .!/g 'Title: Phone No:
Onsite Representative: T�1 /�a6 Integrator: �,
Certified Operator: n perator Certification Number: -�2
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �• �" Longitude ' °
ga tCarrent, �. ---DesignGnrrenf = ti.` r�>:Dei k� Current'•
5wine}rr,Ca es.'Po Matron:,`:Poultry Ca' achy ?Pof"Mahon _-;Caftie �Y'="_Cfl' act Y
Po nlatfon
Vw
❑ Layer ❑Dai
_
❑ Non -Laver ❑ Non-Dairyt
�'
. ❑Other k
r���, x?
r�*Toti Design Capac>Ety' '
S S
�IlCroiLa$OOt ,'Fi Jt ❑ Subsurface Drains Present ❑ Lagoon Area
rManagements
❑ S rav Field Area a
HoPonds CSoI[d Tra �.
fig,, ps.t
f❑ No Li uid Waste S stem,�.�w+�}
rk. 3-.rYh i a.
Feeder
1!
Q
oWean
VF
o Feeder
o Finish
❑ Boars
Discharges & Stream Impacts.
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes )KNo
❑ Yes R) No
El Yes � No
❑ Yes � No
❑ Yes �No
❑ Yes �No
❑ Yes RNo
Structure 6
Identifier:
Freeboard (inches): �� H
05/03/0I Continued

Facility- Number: &z — 3< Date of Inspection r
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees. severe erosion, El Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and:`or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenance improvement? ❑ Yes ERNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 19 No
Waste Annli
10. Are there any buffers that need maintenance/improvement? ❑ Yes X No
11. Is there evidence of over application? ElExeessive Ponding ElPAN ElHvdraulic Overload El� Yes No
12. Crop hype Afgiyr Clc_ Snr.a�.Q ,,d
If
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? El KNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes X No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination'? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16_ Is there a lack of adequate waste application equipment? ❑ Yes PoNo
Required Records & Document
17. Fait to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
{ie/ WUchecklists, des V map; etc.) / ❑Yes XNo
19. Does record keeping need improvement? (ie/ irri till, free oard, waste anaft is & soil sample reports) ❑ Yes FRio
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [$ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/inspector fail to discuss reviewfinspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewerllnspector Name
Reviewer/Inspector Signature:
❑ Field Copv ❑ Final Notes
�I! ~ Date:
05/0.3,V i Continued

Fael,ity irumber: —3G I Date of Inspection
Printed on: 5/30/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
gYes ❑ \o
❑ Yes N \`o
❑ Yes R O
❑ Yes r�tNo
❑ Yes aff".\'o
❑ Yes
❑ Yes 29 No
O5103101

of Visit Qk Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ?$ Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Q oirp DI Time: ; Dd
Facility Number 3
Q Not Operational Q Below Threshold
WPermitted 19 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ........ �__......
Farm Name: ......_!P :�� .. �?!!!................................................................................. County:.......... ^^�; �..... .............� .. Fe-0
Owner Name:
........._. .........1...j............... �!!�1-t.............................................. Phone No �.� .— �� 'GCS ...
Facility Contact: ..........3g.t... 17!............ .J.3...... Title: ......... lnt/.......... ................. Phone No: _. ._......
MailingAddress: �d ��
-- .... 4. r� ..----................................. ..........L..-�;r► ar��. G--................ ? ��i ..
Onsite Representative: ........... '�------------•---.......---------------Integrator:------•........L...........................-......... .. .. Certified Operator: ........-� �' zr-l6 n . esi'� A Operator Certification Number:.... y ...........
Locationof Farm: ................................................. ............ j ._...........--------.... �. ..
Swine 0 Poultry ❑ Cattle ❑ Horse Latitude • ° « Longitude • 6 64
SC_ . Cprre1t Current Desl
on TPflltonvie capacity Cte-
i1rlYnt
cCklmicitk.Po ` itahon'°
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ElNon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total DeS Ca adl
❑ Gilts - P
Boars Total SSLW
Numbei.6f i:ego6ns ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area '-
13aldmg Ponds / Soitd Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 04 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P}-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 19No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on hack

Facility Number: gc1 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes [XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes OfNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelmprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes CYNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ON NO
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
Wo
12.
Crop type L�arhu.ri '_I Siwt_ sm-_U aro-Ifl OS
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
00 No
Reauired Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
JoNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W UP, checklists, design, maps, etc.)
❑ Yes
Od No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
to No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
viQl000ris;01- 0004 0009 -wtrb nQfed d4tt Xg tbjs.vJWJt; - Y;ou w01j-tec�iye do u r
• coirisiwridence: abvuti this visit: :::::...............................
WeAl
ftwza,,e8
t
U0j N.C"Js
} Qou�
5pnxy -Pelds.
Wt, .
NeJ to
e,
tom` wxft$s 4P
J °.,�:
layon
.k pauses
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: l!i 5100

Facility Number: Date of Inspection 4 fo b
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes YNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes MNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [VNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes OdNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IxNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

A, n Q Divilsion of So>J and Water Conservation
Q Other Agetncy 7
of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number �,Z Date of Visit: Jz ! Time: �D Printed on: 10/26/2000
Q --Not Operational Q Below Threshold
® Permitted 0 Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: i�.F �A.Qr County:.... - r
....................................................................................................... .....A ...'.............................
Owner Name: .......... 13 ? �....492 . - .............. ........ Phone No: (.?...............................................................
FacilityContact:.......�/t....,1�............Y..............%Titic:./.............................................................. Phone No:...................................................
MailingAddress: %J / � .... �l��� � / � ��
............... 'r................,,r��................... f........-............ Ci...-..............�,r..l�F..... ............... ........ ..........................
Onsite Representative: .................. .-...........-............. ........... Integrator:... f.P f....,.�'`C.........................
��
Certified Operator: ,,,,,,�;��J�,4i-_.._.. _. � ,,,,,,,, Operator Certification Number: ,,,,,,,,,,,,,,,,,
Location of Farm:
1gr
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� ��� Longitude 0 �� cc
Design Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Z Wean to Feeder `,ael) `p ❑ Layer I I ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver I I JCI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharues & Stream Impactti
I- Is any discharge observed from any part of the operation'? ❑ Yes 52fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q-No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes C9 No
c. If discharge is observed. what is the estimated flOW in gal/min?
d. Does discharge hypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes UNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure
Idenl i fier: .............
.......... � .J..
............................ .
❑ Spillway ❑ Yes KNo
Structure 4 Structure S Structure 6
Freeboard (inches):
5100
Continued on back

..,. ... _.'Jw'An M•r •�34+'�'1 �{ _._— r .T ,.*1�. y... - . ri . . ��:-.'..'�'�✓t': 1."`.-!t„y:.- � .1.., �i N� ♦ .. .: . -�
Facility Number: RZ- Date of Inspection 0 Printed on.• I0/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ,�zj No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,� No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes © No
b) Does the facility need a wettable acre determination? ElYes ,® No
c) This facility is pended for a wettable acre determination? []Yes ,© No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. is there a lack of adequate waste application equipment? ❑ Yes ,$'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc-)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
violafigris;oi•• deficiencies mere hbted during �bis;visiC • Y;oi} Wilt -receive iio further _
correspondence. about this visit. .. . .. .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A!] No
❑ Yes ❑ No
❑ Yes ❑ No
�K Yes ❑ No
Jkj Yes ❑ No
❑ Yes] No
Comments {refer to question 4): Explain any YES answers and/or any recommendations or any other comunents.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A^ �6✓�✓.F � rYC/p .: ��/c.� �' f �✓���Ga.� . /�� ,p �o - � � �
IV
Reviewer/Inspector Name
Reviewer/Inspector Signature: �..-� ` Date: 5100

Facility Number: PZ Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below OYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes CUNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )M No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JK] No
30. Were any major maintenance problems with the ventilation fan(s) noted? (Le. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes J91 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,® No
5100

>>.1 �7
Q Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review ® Other
Facility Number Date of Inspection Zp�3
Time of Inspection 14 hr. (hh:mm)
0 Permitted 4a Certified Q Conditionally Certified © Registered IQ Not O erational Date Last Operated:
FarmName: .............. ..i^........ !'Vlr........................................... County:.......,,,�rd.................... ........ ...............
OwnerName :............ ............. [ i.....`.....-.--- ............---...........—............ Phone No:....�.1.1......:�...f....2.. zl..l�.Y.............. .............
Facility Contact: ........t ryl�i�...+/..Title: Phone No: ............................
7, .. .......................................
Mailing Address: f�.....�/ .lea �r-.mod. �.`...................................................... ..........................
ZP"
Ousite Representative: A-Z ....... Integrator:.._...�rC.�-l4%�-
......................................................................................................................................................................
Certified Operator:....... �dw,fy�.�.... ....., ✓ ., Operator Certification Number: ..........................................
........... ..... ........ .............................................
Location of Farm:
�........... ............................................................... ........................................................... .. -
Latitude o • �' �" Longitude • �' �"
Desig6 - ' 'Current -
a wine
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current :`Design: :Current
Poultry Capacity Population Cattle :._Ca oaci l-Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other I I I-
Total Design Capacity
Total SSLW
Number:of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area -
Holding Ponds / Solid Traps 10 No Liquid Waste ;Management System
w:.
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9 No
b. If discharge is observed, slid it reach Water of the Statc? (Il" ves, notify DWQ) ❑ Yes E9 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 29-No
2- Is there evidence of past discharge from any part of the operation'? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes r--4 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .....................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes Z No
seepage, etc.)
3/23/99 Continued on hack

Division of Soil and Water Conservation - Operation Review
0 Division of Soil and: Water Conservation;- Com" Nance . `
Division of Water alt 'Com lance ins ection U!sP
ecbon -t
Qu h' P P n
Other Agency O eration�Review
10 Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number g 3L w Date of inspection 10
Time of Inspection pa � 24 hr. (hh:mm)
Permitted 0 Certified Q Conditionally Certified Q Registered JE3 Not Operational Date Last Operated
Farm Name: ...........f�i �� Couny---..-
.............. .......
. ..._�..............
Owner Name:........ 9-0... Phone No:.f.�jJ�,.
.......................................
Facility Contact: .....Ac #... M, .. ................. ...• Title: .......................................... ............. Phone No:n..... 9D..r.%/9 ...
Mailing Address: .........+�� ,�,1N ... .�1 .. •'1itCT�/ ... !rI! /V-C-.� ......I ...............
Onsite Representative:!►!!! �i�lt2,d� Integrator: `�.el..-
/ .................................................................................... . .............
Certified Operator.,,."LA!...., _..., Q .. Operator Certification Number:.,.,,,,,,,, .......................
........................
Location of Farm:
........................................................................................
Latitude r�•�° �'• Longitude �• ��� �`
Desi n Current ;
g Design..:. Current Design Current
Swine. -, _ - Capacity Population Nn61tr9 Capacity -Population Cattle Capacity Population
Wean to Feeder
p d
jj
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
g ❑ Spray Field Area
,Number of -Lagoons- Subsurface Drains Present ❑ Lagoon Area
Holds ig Popds / Solid Traps - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes % No
h. If discharge is observed, did it reach Water of the Statc? (If yes, notify DWQ) ❑ Yes WNo
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes P No
❑ Yes V9 No
❑ Yes jPK No
❑ Yes fin No
Structure 6
Identifier:
Freeboard(inches): ............. ..�... .. ...................................... ................................... .................. --............. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes M No
seepage, etc.)
3123/99 Continued on back

l Facility Number: Z — Dale of inspection
0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
,�J No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
JSLNo
12_ Crop type,se�/.
13. Do the receivtnp crops differ with those designated in the Certified Animal Waste Management Plan p g g • (CAWMP)?
El Yes
)� No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, q• design, maps, etc.)
VYes
❑ No
19.
Does record keeping need improvement? (ie/ irri freeboard, waste analysis & qa_ i e reports)
XYes
❑ No
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
){ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JRNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
§4 No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
191
0 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
:: o vWati6ris:or dcCciehcies were noted-. Wt . g 1hisY:oif :will•reed*ci ii6 fui-thgr
6 resporidence'abo_ UAthis:visit-'•:•:•'-:-'-'-','-'-'•:•'-',' :::::::::::: ::: :
Comments {refer to -question #)Explain any YES answers and/or any recoinmendoas o=>y other comments r r
Use drawings of si facility to better explain tuations (use adtLtronal pages as necessary) Az
iq. Ax
c.4
1/461'� F.We
lReviewer/Inspector Name r -`
Reviewer/Inspector Signature: .«% Date:

Facility Number: 1 — Nate of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
XYes
❑ No
liquid level of lagoon or storage pond with no agitation'?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
RNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29-
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a perntanentltemporary cover?
❑ Yes
PRNo
ition omtnents an or awm —
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality`
® Routine O Complaint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Date of Inspection g-
Facility Number
Time of Inspection d: as 24 hr. (hh:mnn)
© Registered K Certified 13 Applied for Permit [3 Permitted 113 Not Operational Date Last Operated:........
,
Farm Name: ........... -'..I,Q 7. p� �(.1...k....................................................................
O-Amer Name:.......... ` Cr �f.l� ...........................LIST i.... . ........
Facility Contact:---...---UG,f, ........ Title:
® D-
Mailing Address: ---.--•----- ... )_— .�. �.!% ...... lra . ....l l...... . ...........
Onsite Representative :............ V,l &ll............ A 7 ..........................
Certified Operator: ................ k Lit.G_...C..................................
Location of Farm:
County:...........!'1...................................
Phone No:................11�.' S a2`` ........................
................................. Phone No:.....------........................................
1,......1'C...................a3
Integrator: ................
Operator Certification Number; ....... f /a........... .. .......
Latitude �•�' Longitude
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
Is any discharge observed from any part of'the operation?
❑ Yes
No
Discharge originated at.: ❑ Lagoon ❑ Spray Field ❑ Other
EVNo
a. If discharge is observed, was the conveyance man-made?
❑ Yes
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
i] No
c. If discharge is observed, what is the estimated flow in gal/min?LIZA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
XNo
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
ANo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
((No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
A
7/25/97

Facility Number: M-36-
8. Are there lagoons or storage ponds on site which need to be properly closed:'
Structures (Lal;oamr•.lfold ing Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ........ . ........ ..............I.
14. Is seepage observed from any of the. structures''
11. Is erosion, or any ether threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/iniProvement?
❑ Yes X�Nl0
❑ Yes *N0
Structure 5 Structure 6
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level mari:ers`
Waste Application
14. Is there physical evidence of over application?
(If in excess of WI IP, or un -fentering waters f the State. notify DWQ)
-fir, .r1a.aMcm,nt
..... .....
15. Crop type.......................�......................
16, Do the receiving crops differ with those designated in the Animal Waste Plan (AWMP)?
t7. Does the facility have a lack of adequate acreage for land application?
18, Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[] No.violations or deficiencies were noted during this.visit. You.will receive no further
correspondence about this visit.
❑. Yes
❑ Yes
❑ Yes
910
No
❑ Yes W No
❑ Yes No
.......'.....
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Ycs
X Yes
Cl Yes
❑ Yes
Cl Yes
tPlNo.
X No
[(No
giNo
�XNo
9 No
❑ No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments I
Use drawings of facility to better explain situations. (use additional pages as neemsarv),
I,D
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: /� L„�J , I$Iti�— Date: A,-1;0-~

1 0 Registered [I Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Farm Status: ❑
'Certified D Permitted or Inspect -ion (includes travel and processing)
F-1 Not Operational Date Last Operated:
Farm Name: — 4 4.1 if 1 -e,- r.. . -.. - - - - - - County.,
Land Owner Name: . ..... Phone No:
Facility Conctact.- Title: Aw rt&Ar Phone No: ... . ....
Mailing Address: N C- 2" 2-T
OnsiteReprescntative:.&�.--. . . .... . .... Integrator:
Certified Operator: . . ...................... operator Cerfification. Number:
Location of Farm:
r.. 61a ..... J.Wzz— 0
0
Latitude 0 4 " Longitude 0
Type of Operation and Design Capacity
n
Current&
a�'
CViDaI u N0V
uiatton4
[I Da -
Feeder to Finish ❑Nan La 0 Non pairyl Non-1
..........
I0 Farrow to Feeder 'Dign'ach
y le 012 :'n'ls roz Al,
10 Farrow to Finish Ap
❑
Other
Total, SS
7 �7
10 Subsurface Drains Present
agoon A= OF
Area 0 Spray Field Area
L
-G-e-neral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at, [I Lagoon [I Spray field C] Other
a. If discharge is observed, was the conveyance man-made? '
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
[I Yes No
El Yes No
[]Yes 0 No
E] Yes 0 No
❑ Yes
[I No
❑ Yes
No
❑ Yes
All,
No
❑ Yes
XNo
Continued on back

Facility Number: ..7K —.. TT.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
'P�V0
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
S. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
PNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
ONo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
19No
I2. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid Ievel markers?
❑ Yes
XNO
Waste Application
14. Is there physical evidence of over application?
❑ Yes
ANo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type GL — G real
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
gNo
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
0,No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0No
For Certified FacilkiesQuLy
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
Cl Yes
ANo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
24. Does record keeping need improvement?
Yes
❑ No
Comments (refer to`question #). Explain any YES answers and/or;any recommendations or any other cornments.
Use.drawrngs of facility to better exe.plain situations. (use addrtronal pages as necessary):
b;
t-12. Needl ►rww arou �ro► a l�bo►- • �` 4
:$tz4. Meed 4o kcep irriga�er.- recZI-As an -i:RA I 47--para1s,
A�56
J
Ho
Reviewer/Inspector Name
Reviewer/Inspector Signature: C. Date: Ld-13 - ]—]
cc: Division of Water QualiM ater Ouality Section. Facilitv Assessment Unit 4130/97

Facility Number. �,3�,
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: z '<'3
Time: : S U
Farm Name: County:
Owner Name: Phone No: 5 V 4-
On Site Representative: Integrator. _ Pce-,
Mailing Address: � } 1 &x r i 5 - VE _
� r t'
Physical Address/Location: -5-F ! ! Do j� .52 / cO 7
' • Latitude: I I Longitude: I I
Operation Description: (based on design characteristics)
Type of Swine
❑ Sow
P&Nursery
❑ Feeder
No. of Animals
Livestock
Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Layer O Dairy
❑ Non -Layer ❑ Beef
Number ofAnimals:
Number of Lagoons:, _ (include in the Drawings and Observations the freeboard of each Iagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1-foot + 25 year 24 hour storm storage?: ti 2 rZ--/ Yes O Now
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops vhi d - rovement)
Crop type: Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste Iand applied or spray irrigated within 25 feet of Blue Line Stream?
AOI — January 17,1996
Yes ❑
No'®,
Yes ❑
No$7
Yes ❑
No$�(
Yes ❑ NoAe
YesVr No ❑
Yes O
NcOU
Yes ❑
,Noid,
Yes ❑
Now
Yes O
No'

Maintenance
Does the facility maintenance need improvement?
Is there evidence of past discharge from any part of the operation?
Does record keeping need improvement?
Did the facility fail to have a copy of the Animal Waste Management Plan on site?
Signature:-
,.
cc: Facility Assessment Unit
Drawings or Observations:
0
Yes ❑
NoIct—
Yes ❑
No�C
Yes ❑
No ❑ %
Yes ❑
No ❑
Date:--- 2 _— f l _- 574--
Use Attachments if Needed
. .. __. -- •-rs�rTr^t.-�r..r nsz - - �r., swta�tt �N' nrm r; t. !.r•..,�Y.-.rT+'a,-•'••Yfr -�k:' _. -
AOX — January 17,19%

Site Requires Immediate Attention: /V 0
Facility No. 192- 3 6
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: T t g , 1995
Time: 15 , 3 to
Farm Name/Owner: A l pi K e Foo- t-� / B e 4y H t r r i N 24 . LNow4C C t,c u:l * -D w.
Mailing Address: Rk f_ 'E4( 5 EE C'_f;"_Jy" MC c
County: Sampsotj
Integrator: Q s .1}1 c Phone: 05-771
On Site Representative: 14e.r r i r4 4 Phone: (gVo) SR Z - Z*0 *
Physical Address/Location:
Type of Operation: Swine ✓ Poultry _ Cattle
Design Capacity: Coo O Nurser Number of Animals on Site:
DEM Certification Number: AC DEM Certification Number: ACNEW
Latitude: 39- ° 41 ' 15 " Longitude: 7 3 ° 13 '*5"
Circle Yes or No
Does the Animal Waste Lagoon haye sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes r No &�NWas
Freeboard: �' Ft. 4 Inches
Was any seepage observed from the la oon(s)? Yes o any erosion observed? Yes o No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Ye or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin . Ye or No
100 Feet from Wells? Ye9 or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ortlto
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o&
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ojS If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:
Maiuf. ctioNscd
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

o + -/Ij
/ 3�
NORTH CAROLDQ DEPARTNMgT OF ZMVZRDi+U T, H8ALT8 A MATET AL PJ SOM=
DIVISION OF ENMONMENTAL PUJULGIIMEVT
Fayetteville Regional office
Animal Operation Compliance Inspection Form
'i- Y �'YI.. :::.:y ..�... a....- `.ttsK .yJ.v. !^'
NAlrfSf OAR .�'�'r r
-P"�-.w-:'-.:>^�.r•.�i+:an'��Fwa�.•. •��r��r .: �' �, � •.r-.0 i.<.;l-.. ' Y^"^, .. :-...:
- x �
.�AAM ��'�' r
� ;II+iSFP.CTZDN -DBTE ,FARM .
Ali ne Farm Herr! n
ice( i �S Jq 9
skV':.:n..,<�..ka:.iH3-l+i-i\V ..11l1iRi�Fh7�7. ��x N•�w~�.�'�
woK. N .. �'� ii4.ZL :'..i i�A+C�ULi\IS' S�l1Ci0�,�:"� +�~
12t I BD)c CI inkun 8
Cgr�)5Qa �qb4
All questions answered negatively will be discussed in sufficient detail in
the - Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation T e: �o rs`11
Horses, cattle, saline poultry, or sheep
$EG"TSON 11
Y I N I Comers
1. Does the number and type of animal meet or exceed
the (.0217) Criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry (30,000 birds with liquid waste
systwa) 3 - '
2. Does this facility meet criteria for
Animal Operation MIS TION•?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIY= ANnUM
WASTE MANAGMCMr PLAW.
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
5. Does this facility meet the 5CS minimum
setback criteria for neighboring houses,
wells, etc?

$BC71I=I
jt1214 Site banagsmen
1. to animal rasLu sLuckpiled Or lagoon
construction within 100 ft. of a nSGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated v4*h4n 25 it. of a UZ00 Maps
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. noes the land application sits have a
cover crop in accordance with the
MTIFICATIQ" PLAN?
S. Is animal waste discharged into craters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
f:. Does the animal waste management at this
farm adhere to Rest Management practices
(2MP) of the approved CERTrrICATXCW �J
7. Does animal waste lagoon have sufficient [� T
freeboard? How much? (Approximately �)
$. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
§=IDlN IV
Comments

,
MA
00 1;001v"
00
2
1,104
A
,I ■f/ q mMll GPM laws
i�° 4 •�41
a �
go
00
NO
O�
P
0
PIP
A!Y �r
14 V >�
00
y y �
, u
ALPINE FARM:
BETTY HERRING II
fN From 421 feed mill take 421
south to tlarrell's, turn
right on 1007, go 3.6 miles,
turn left an SR 1100. Farm
is .4 on left.
f
Ill V
1

,A-n= L•_ AMSTZ INCA -G22C i"P iLa.Y CZR--=7==IT=Z T ?OR MW CR M: a2i..?= ?--Z=L0TS
71aasa =at•.:-= tog c= piatsd ;ca to tap =Iyis_an of z=v!=t==a=tai wacagaaa== am
tha add=ese as to* =ava=ps Mich of t`.', _o=.
Nawe of :a_= (Please print): ALPIAE FARNVS
Ad.i es s -rI 8e 2S IS E a
Cc,nron 2-83 ZA ?hone No.: 4110 5 1 AWL -.Z KC9 q-
County : SAe+A5o Q
Fa_m __cac_on• :.ac__.:de and Lar_situde:jq2 ±f i5" /78' 13 -ff"(,e;,. red) . Also,
pease attach a copy of a county =cad map with location identified.
Tj7e -4 og.e_ation (Twine, layer. dait~y, et_.) : K !IE
esign zapac=t-r (-z=her of ani=als) : 6Q245 WCA4- FcSD
Average Sire c perat;on (W mcn_._ pcpW!at_or_ avg.) 45000 We4n F
Average acreage needad for _anal application of -aster (ac=es)
sassa��fa3agtaassassassa 4sra:assaaaaaasass s��aaaaa=a asaasaaa==:ash=a:a:aaa3aaaaaaa
'^ace;=al SaeeialisL C� _ice-_atiaa
As a nec: ._ca? specialist desiq=atsd by the Norm Cartl_.a Soil and Water
Conservation Comm;ss_or_ _ u_ssaat to 15A NCi.0 Sr' .0005, i cert_=y that the new or
nVanded a.r-i=aw waste management system as installed for the =a_^ named above
has an aalml. :caste =arageme_ = plam that Meets the designs.
ooer;t_CCl and maintenance standards earl Specifications of the Division of
Zavi o. mental Management and the USCA-Soil Conservation S'err:--a ai di -- a SIG_ -
C.a_-al_n a So,_ and Water Corse=7anion Cc=iss_cn pun=suart to 151 MAC ?H.0217 and
15A NCAC 67 .0001-.0005. ';"_:e following Kements and -.lair co__espor_ding
by me or oche_: designated tac. specialists and
are 4included. Ln the plan. as applicable: milA==-+ separations (:u;;ers) ; liners or
equivalent far lagoons or :caste storage ponds; waste storage capacity; adequate
c_anti=y and amauzz of lard for waste utilization (or use of third d pa= =r) ; accass
or ct.._ersh&p of proper :caste application equipment; sc eduie for of
a___lic__icns; application races; loadA=gg rates; and the c_rt=ol of the dischazge
of vollu xm=z from szor=rrater =xnoff Svencz less severe than the Z5-year, 24-hour
stogy. -
Yaao o ;e Tecaical SveclaLIIst (Please Print)- _ C7 • d i-e n n C t r aTa n
Affiliation-.: PAv5rAse IWACmr. ?..a.
ndd ess (Age_-C- : D Lld 7a/1 n C Z8 ?hone No 910)5 2. - S 77I
Dace:
aasaaaaaaasasasaaatanMMM.amM=MaaassaasaasWsMsasasMMMa=a:a=ss
CtJaA=�'Ya�..a�oS .1�=ea�aL
1 (we) tr_derstard the operation and ma.i_ncazance procedures established i_z the
a_praved atsima'_ waste management plan for the :a--= named a=ove and will i=pleme^.t
t ase p_ ocezures . I (--re) know Sat any additional expansion to the existing
design capacity of the waste treatment and storage system or ==3r- .Ic__on of new
facilities will ree(Z i_e a new tea==-ficacion to be submitted to =he Division of
�Znvizon=.encal management be=cra the new arms are stocked_ _ (we) also
=_dersta d that :here must _e no dischar7e of an0al waste f=o;n this syscem to
su==ace -wat=rs of t _e state either =2==ug a man-made ct.:reya ce �r t+:r:ugh
-_ nof_ from a stY== event less severe than th_ 25-year. 24-:^_ouy sto=. he
approved __a.r. will re riled at cite fa-� aril a the offic_ o= t :e local Soil and
Na=_.. C=rse> >a_;c :
:ta=s of Maad Gtirn (Please Prinz)
Data: 0 /n
� v
NK=m of v..=.:aCar, if dif=__e^t from owner (?lease priat) .
aignat_re• Cate-
Y_t�: A cnaunge in land ownership resi_ss ^cti__cation or a ,esr csa___:cation
(_f the appraved plan is changed) to ie suh=ittad t= t: a J-vis_or. of
✓:.v===P^.en=al Manageffien= ;rt_..-n iO days 7C a .~ills t=ansfe,.
DY' USE CN'LY.AC:s":4

DC-PCTM enr of cnvircrmEn%,
heci;h and Neturc! Resources •
CiviS;Cr, Cf E vircrrentci �Mc^cyem, ent 'OALA�N;A
aft
�cmEs 3. Hiurt, Jr.. Gcverncr ioft
!cnc�nCn S. ;-ewes. czec.etcry "
A. resscn Hcwcrt, .:r., P.E., Direcjcr
I5_`RCTC';;wNS =C.Z Cw :'_r �GyT_CN CF peRC'f� :,i�I::��'-t� +i.�.S ;' .`rA.�Ia�.Gr.*'....�1T Ur "Is FOR
CR =C:- M_ A ff=IQ L X-AN ..i!T SYS7=1''S SZRRV_iG L-TS
--e 7e=it_ed by t e :)w-r4s­=n of nvi_anmental Haragement
ewr:e= of- any new or ex;,anded armal waace management syster.:
�cr.st�.:c_ed aftaw- ;aazuz=y 1, 1994 :raic` is designed to se -.re greater th. n e=
L e a:* a_ ;:cpulacicn5 lister+ aelcw is requi=ed to suitazt a
ca�i;_cac:cn �ar3 to 0=1 t a new arzmals are scoc'ced on the far.
_asC__e Qpe,atiers axe exe=¢t farm the=egTai=emenc to be car_=;zed_
100 head Q cattxa
7 S hawses
250 swine '
1, 000 sheep
30,000 b4 .4 wfth a Lgmid waste system
�'Ye cer_i:zcaczcn must be signed} by the owner of txse feedlot (and Manager if
d__;a=snc 5_= the cwrer) a: a by aazy tsc!=_i=1 spec_aiist designated _,y the Sail.
are Waca= Cc:sse_-•rat;au Commission pursuant to x5A NCAC 6r' _ 0001-.0acs. A
=ec-�.icai sYec_a? ist mz.:sz reri�y L-v an aim-sica i.-Lsaec_;an that all applicable
design and _angry tctzcri standards aad sgec;s;catzers are met as installed and
at all applicable operation and maintenance standar'.s and specifications can =
be Mac.
AIthcug^ t_ha ac_sai rum er of animals at `=e `ac_I_t1 may *rar'i -= tie to tie,
t he desig : capaciti of t'ze waste handlz :g system should be used to dece_—_%L=e if
a :arm :s subject to M.Ie ce_-ti icat_0n =squilement. For exa==ie, the waste
sysca= =cr a feedloc :s design;; to handle 700 Nags but the average Pazulatzoa
will be Z00 hogs, than the waste management system requi=es a cerci:icaCian.
.his Certification is =-+cuired by regulations gave__^..i_ng animal =rasts Management
sysc:a^s adapced by the S vira=encal Management Ccmmissian (:-Y-C) are Cecamber 10,
_392 (Title i 5A NCAIC ZH . Ozi ) .
Ca the rsvprse side a. this page is the cL_r ___cacion fc= whi.c^ =st be
tc 0=`! before new animals are stccked an the far. Asswscance iz.
the _ -_.., car_ Me data -red -_ t ..re o! the ? cca'_ ar,, ic•_ltu_ra agenc;es
�..�_ as the sort art_ -water ccr_se= raci .- .isc=ict, the tT,SCA-SC,l Corse; racicr.
Serrice, cr the N.C. C=c;,e=atzve Zx=a3^Sian Sa_—rice. The io= s cull '.-.e se--c zo:
Zeeaz=er.t or-r__onment, realth and Nat ---al Resaui=es
3i r -sicr, or Z=-r; ar=rental Maz:ageWer.4
roter Qua! :t,( Sec__or-, Fla.^.nirig Branch
P.O. Hcx 29535
Qaleig. q.C. 2.iZ5-o535
Phone: 919-733-SCe3
Steve W. Tedder, Chief
Water Quality Section
?ate IJ: AC:rZWOZ94 Sate:
PA. 3cx 2C53.,. ^<ca+�Z. Ncr--i C=iir-, 27626=' ie+ecrcr.e 414-7:-701=