820047_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

ype or visit: kZ: Jompnance inspection v uperatlon Kevlew U structure Evaluation U 'l"ectinical Assistance I
Reason for Visit: (DIlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: ', (� Departure Time: County: T f -A Cp
Farm Name: _ 1-06,f -N gfit. L N Owner Email:
Owner Name: tZ-,>(­e4, ! 4u%��4-q Phone:
Mailing Address:
Physical Address:
Facility Contact: �,��; e 't _ Title:
Onsite Representative: f
Certified Operator: t
Back-up Operator:
Location of Farm:
Region: r(Z-0
Phone:
Integrator: :� czyam
Certification Number: 67 5
Certification Number:
Latitude: Longitude:
Discharees and Stream Impacts
i. Is any discharge observed from any pan of the operation? ❑ Yes []-N6--❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Design Current
❑ No
Design
ON
Current
C. What is the estimated volume that reached waters of the State (gallons)?
ine
Capacity Pop.
Wet Poultry
Capacity
Pop.cPop.
My
Wean to Finish
NA
La er
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q"No
Dai Cow
❑ NE
Wean to Feeder
1;ev
Non -La er
❑ NA
❑ NE
of the State other than from a discharge?
Dai Calf
Feeder to Finish
5`7k f
Dai Heifer
Farrow to Wean
-
Design
Chrrent
Dry Cow
Farrow to Feeder
D . Poul , °
Ca aci:
P.o .:
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
i. Is any discharge observed from any pan of the operation? ❑ Yes []-N6--❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ 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
Q"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6 -'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21417015 Continued

Fqcility Number: L - Date of inspection: v4
ZT1
[moo
D NA
❑ NE
Waste Collection & Treatment
❑ Yes
❑kNo
❑ NA
❑ NE
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I_31"-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
©- 11AA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
the appropriate box.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ED -NV-
❑ NA
D 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
0<0,1:1 NA
D 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
CTNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L1 "'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 71�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 9 S 6 0
13. Soil Type(s): L'd 0 r�) q-
14.
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑`No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[moo
D NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑kNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Z�Co
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�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 [3-<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 eNo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: -q jDate of Inspection: /I ✓�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes lgIvo
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 9311V0
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o
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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [v]'Fo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes EZINo
❑ Yes ❑ No
❑ Yes r No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question # Ezpliiun any YES answers andlor any additional recommendations or any other comments.
Use drawings oft faH ty to hFrter explain situations (use additional pages as necessary,).
eyy
Reviewer/Inspector Name: {'a t ��
f� r
Reviewer/Inspector Signature: ,vrhl
Page 3 of 3
Phone..ju, `1 `1 `33 3
Date: { i
2/4!2015

_ j%,kkS 10 Tu13-0
Division of Water Resources
Facility Number 11L�J - Division of Soil and Water Conservation
® Other Ageney
Type of Visit: Co liance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: %{}l !, Departure Time: C3 County: �� Region:
Farm Name: fly:tAvla�� Owner Email:
Owner Name: _ 2p0�c/t.i e1�fLivl1d �`� Phone:"
Mailing Address:
Physical Address:
Facility Contact: �J g. fJ`r"t Title:
Onsite Representative: f
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: /
Integrator: Rfty4n-
Certification Number: ^ / •5'd
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes.. notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [a' 1—❑ NA ❑ NE
❑ Yes
Design
�.3
Current - Design
Current
Design Current
Swine
Capacity
Pop. '`W,et Poultry, . Capacity
Pop.
:Cattle Capacity Pap.
-
Wean to Finish
La er
Dai Cow
Wean to Feeder
Q
Z Non La er
Dairy Calf
Feeder to Finish
Ujo+
Z�
Dai Heifer
Farrow to Wean
�� y�Design
Current
D Caw
Farrow to Feeder
DPoultr,Ca aei
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Turke s
-
Qther -
Turkey Pou Its
Other g- 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)?
❑ Yes [a' 1—❑ NA ❑ NE
❑ Yes
❑ No
D -NA
❑ NE
❑ Yes
❑ No
[I—NA
❑ NE
d. Does the discharge bypass the waste management system'? (if yes, notify DWR) ❑ Yes ❑ No [TNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [D -No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

FaciliV Number: I - Date of Inspection: t 37 -or r< V l
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
Eg-lqo— ❑NA 0 N
❑ No +0<'A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
Spillway?:
Required Records & Documents
�
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LvJ No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
Q -M
❑ 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
[�1 fo
❑ 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?
❑ YesNo
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E3'go
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 > ]0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): G.r .Cg s C_ Ci _
13. Soil Type(s): �}G For
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 ❑'1`lo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ERINo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ug'<o
❑ 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
LvJ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ 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 [J`No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [TNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETN o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA 0 N
Page 2 of 3 2/4/2015 Continued

IFacilitY Dumber: Z - Date of Inspection: x & /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes UP4ii ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes ER<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 ofan actively certified operator in charge? ❑ Yes [g -go ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to -properly dispose of dead animals with 24 hours and/or document
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 1 No ❑ NA ❑ NE
❑ Yes Ef -1do ❑ NA ❑ NE
❑ Yes do ❑ NA ❑ NE
❑ Yes i No ❑ NA ❑ NE
[:]Yes
�o
❑ NA
❑ NE
❑ Yes
[j] No
❑ NA
❑ NE
❑ Yes
E?,Q/O
❑ NA
❑ NE
Comments ( fer to u )' Ezpfaiv any'YES answers and/or any additiunna� ations a'r any other co pments
Use drawings of:fac�iy„to �� � explain ( pag ) �n
estap d
better e . fain situat}ons use additional es: as n
{ L4 5 %
Reviewer/Inspector Name
Reviewer/inspector Signature
Page 3 of 3
III
c-eII cl,U-3-LE-11S I
Phone: qj b- f 3J 3-33
Date: Ttl( 1
21412J15

Type of Visit: Q Com ance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Twp Arrival Time Departure Time: County: � Region��
Farm Name: ' 10" �p.��tJ I1n"—��..at a Owner Email:
Owner Name: iz_QL e_ 111�0 V, "I Phone:
Mailing Address:
Physical Address:
Facility Contact: IL tw Ile Title: Phone:
Onsite Representative: Integrator: lort__S �
Certified Operator: { Certification Number: r,
Back-up Operator: Certification Number:
IC 7S
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
Design Current
Desig�ty
Design
Current
Swine
Capacity Pop.
❑ NE
Wet Poultry
Capac
Cattle Capacity
Pop.
a. Was the conveyance man-made?
Wean to Finish
❑ No
[JA
La er
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
Dairy Cow
[]NA
Wean to Feeder
O
EL
INon-Layer
I
Dairy Calf
❑Yes❑
Feeder to Finish
S a
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D'Kio
Dairy Heifer
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Farrow to Wean
[3,<o
❑ NA
❑ NE
Design
Current
Dry Cow
Farrow to Feeder
D . Poul
Ga aci
Plo .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
No
DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[JA
❑ 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? (1f yes, notify DWR)
❑Yes❑
No
[31<
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
D'Kio
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[3,<o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/412014 Continued

Facili Number: - Date of Ins cetion:
Waste. Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �To ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []-l�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): "j 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [nNo 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 [B -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 CEI Nlo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes [ -1vo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[BINO
❑ NA
[] NE
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ❑'moo
❑ NA
❑ NE
maintenance or improvement?
!-
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes Io
❑ NA
.r,
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [TNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): LJp p AVA4*'1 F A175 f O'.t
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?
Reauired Records & Documents
[:]Yes
[B'No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[BINO
❑ NA
[] NE
❑ Yes [3'No ❑ NA ❑ NE
❑ Yes []'�Io 0 NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ o 0 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [3No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists p Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes []'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [D"No ❑ NA ❑ NE
Page 2 of 3 214/2014 Continued

l;ac Number: - LEI jDate of Inspection: 8t) lbWJ:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!3No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EKO ❑ 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 [jNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Zyl�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes E'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes El"'No ❑ NA ❑ NE
❑ Yes 0"No ❑ NA ❑ NE
❑ Yes [3"'No ❑ NA ❑ NE
❑ Yes E]"No ❑ NA ❑ NE
❑ Yes dNo ❑ 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).
(Z.t �- �`Io-[3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L03
Date: ?7
2/4/2014

type or visit: kzi'cmnance inspection V vperanon Review U notructure Lvatuation U tecnnicat.assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / �tA ►`j] Arrival Time: Departure Time: Q(. CD county: �� Region:rr �—
Farm Name: �71 60A LaI �iy /•z C Ekl +&_ Owner Email:
Owner Name: 1j o kc ­_t$n� Phone:
Mailing Address:
Physical Address:
r p 0 't
Facility Contact: Title: �6 6 � � rL
(1
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
I
Latitude:
Phone:
Integrator: py�rt{
Certification Number: le /
Certification Number:
Longitude:
Dischart=_es 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 Cg4o ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes [:]No
❑Yes E] No
❑ Yes �lo
❑ Yes 2-5o
3<A ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 1/4/2011 Continued
Dn Current
Destgn Current
Design Current
Swine
Ca�pac�tty Pop.
Wet Poultry
t;. 4»
Capacty Pop
Cattle Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
—r
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design, u�rent
Cow
Farrow to Feeder
D . Poul
�„ nom_
Ca aci ":'P;o :_
Non -Dai
Farrow to Finish
Gilts
Boars
La ers
Non -La ers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
Mill
Other
r;
,. ..
Turke Poults
Other
Other
Dischart=_es 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 Cg4o ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes [:]No
❑Yes E] No
❑ Yes �lo
❑ Yes 2-5o
3<A ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 1/4/2011 Continued

[Facility Humber:- Date of Inspection: J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [d]'1Qo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [2'1�o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4E:rNo ❑ 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 io ❑ 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
ETONo
❑ NA
❑ NE
8. Do any of the structures 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
❑B Ro
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
[l No
❑ NA
❑ NE
Waste ARplication
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
❑ Sludge Survey
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9110
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
F�No
❑ NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
' Na
❑ 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 /` , k, n -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW4. .
❑ Yes
E�?No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesfN,o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fNo
❑ NA
❑ NE
I8. Is there a lack of properly operating waste application equipment?
❑ Yes
[0"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
hio
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
[l 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F�No
❑ NA
❑ NE
Page 2 of 3 2/412011 Continued

Facili , Number: - Date of Inspection: L.
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes EJ No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesD<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 to provide documentation of an actively certified operator in charge? ❑ Yes E?Co ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
23<o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Egl<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
E24o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
g3"5Z
❑ NA ❑ NE
p Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E24o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Ef No
[] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej'*No
❑ NA ❑ NE
Comments (refer to cguestion #1): Explain. any. YES answers.andlor,any additional recommendations or any other comments:`
Use drawings of facility ta,betfer;;explain;situatiuus (use additional.pages as necessary):
:
�*,�,1411
t o - a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonel10 ,. _73 —33J
Datel Jay I
2/4/2014

i s k;
Type of Visit: 0Com Hance 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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Counbs-
Farm Name: _ e3 t "Aj Owner Email:
Owner Name: Phone:
Mailing Address: l W. a P
Physical Address: 677 7ti) �) 6u, loj Q
Facility Contact: b / Title: 2EE21= Phone:
Onsite Representative: I l Integrator: - ( rm L'r 5 to �
Certified Operator: q Certification Number: /4 ! Sc
Region:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
L
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D
Non -La er
,_s
D , P,o_ul
Design
Ca aci
Current
P,o
Daia Calf
Daia Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ot#er
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 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 [g < ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes [—]No
❑ Yes [—]No
❑ Yes QXo
❑ Yes [y�To
D A ❑ NE
[B -RA Cl NE
CR*RA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2011 Continued

Facility Number: 04 Date of Ins ection: tj
Waste Collection & Treatment -�-,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in): �—
Observed Freeboard (in): 32, gj�.�.
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [U Nb ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[-vrNo
❑ 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
[3'�4o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]J No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
EJ�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): Zyl1 G
13. Soil Type(s): re
14. Do the receiving crops differ from those designs ed in the CAWMP?
❑ Yes
2 -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
[Zwo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[jL>o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Ido
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:q to
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑Ao
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[;?No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [I -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 allo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

©-�
Reviewer/Inspector Name: On Phone O
Reviewer/Inspector Signature: R+ Date: Is (a
Page 3 of 3 2/4/2011
ri
.1
lt.Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [!Mo ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes [?3'lqo ❑ NA ❑ NE
the appropriate box(cs) below.
❑ FaiIure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ [Von -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 [2' -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [9"N'o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [3To ❑ 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 [DNo ❑ 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 []�'1Qo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes []rf�o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes [;),No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes []k*&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: On Phone O
Reviewer/Inspector Signature: R+ Date: Is (a
Page 3 of 3 2/4/2011
ri
.1

Type of Visit: UCompHance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit:
Arrival Time:
Departure Time: Q'.4
County:-- Region: r6
Farm Name: �'����
S,,.nt.NL rgAgns fs%A
s Owner Email:
Pop.
Owner Name: a>"'. to Phone:
Mailing Address:
Physical Address:
Facility Contact: '_Zk', Title: Q w rs %, (L Phone:
Onsite Representative: S NM F— Integrator: '� R F --,A 09 E
Certified Operator: `6. 7". t) Certification Number: G q L7 5 Sg
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dischar es and Stream Im acts
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 dNo ❑ NA ❑ NE
❑ Yes
urrent
I f7Design Current
Design Current
❑ Yes
❑ No
E*!;!6
city
Pop.
aWet PoultryF {Capa_cEtyPop.
Cattle Sagacity Pop.
❑ NA
w
Wean to Finish
La er
Dairy Cow
Wean to Feeder
"1u
11
-Layer
Dairy Calf
eeder to Finish
'j
a= -
Dairy Heifer
Farrow to Wean
= SDesrgn 'Current
Da Cow
Farrow to Feeder
D , :,P,oul $,C Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es and Stream Im acts
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
d No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

Faciti Number: -y Date of Inspection: /Q /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier.0
Spillway?:
Designed Freeboard (in): k S /'2
Observed Freeboard (in): air 191�
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes Ca'No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
dNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[]Yes
[2/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[Z"'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
[S](No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[-]Yes
dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
p PAN ❑ PAN > 10% or 10 tbs. ❑ 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): mm uA f* ��:g.�i � G-0
_
13. Soil Type(s): � •R t5lvl� A 2A rrt Ucnli ti s Ao V\
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E?/No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[-]Yes
a/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[.i 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?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [(No
❑ Yes WNO
❑ Yes dNo
❑ Yes WNO
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E?(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ RainfalI ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes E�fNo ❑ NA ❑ NE
[:]Yes []/No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

FaciliNumber: a - LNI Date of Inspection: p a,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2(No ❑ 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 dNo ❑ 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
dNo
[] 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
dNo
❑ 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
14 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
p Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EzNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
WNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ff No
0 NA
❑ NE
r�l~e.cJso5 Q e \'� m cam%J Aar
V - P R, W t.i1 rnAscjA Pa,•'r P
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
.\ Q .
Phone: CA&'
Date: /
2/4/2011

ype of visit: ® uompiiance inspection V Vperation KeVleW u Ntrueture Evaluation V I echnicat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: s q Departure Time: County: Islam Region: r- RD
Farm Name:
Owner Name: 6 3152P./tTUA)
Mailing Address:
Owner Email:
Phone:
Physical Address: "�
3 �, [� 4;9xp o
RO oS) i
e U f"MQN' 1J C •
igCurrent
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
_
Facility Contact:
(¢ J
Title:
Q Lj a, .tQ Phone:
Onsite Representative: Integrator: ARCS
Certified Operator: �(� R , ` !�h y�-�� Certification Number: CtQ
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-fP%t
Swine
Wean to Finish
Wean to Feeder
Design- Current
Capacity Pop.
Q
Wet Poultry
Layer
Non -Layer
igCurrent
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
Feeder to Finish
(¢ J
"'+` °
.
Dai Heifer
Farrow to Wean
Design 'Current
Dry Cow
Farrow to Feeder
D . P,ouIt .,
Ca amici ' . pPoM.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pultets
r jBeef Brood Cow
Turkeys
Turke Poultsher
OTher
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Z No [:]NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No M NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [-]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes No ❑ NA ❑ NE
of the tate other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facie Number: a a - Date of inspection: ja
I f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[A No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): V�
Observed Freeboard (in): ALA—
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
P 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
R] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
N] 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
V] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JEW No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes _tANo C-] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��itrnrr t�Y 1 rSr�f�
13. Soil Type(s):FO(i LS4 £R rn
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 [A No ❑ NA ❑ NE
rvf
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L,^j 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?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes E f ,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 [§ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jb No ❑ NA [] NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of inspection: '} 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [� No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [@ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [A No
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [t No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
[:]Yes Qg No
❑ Yes % No
❑ Yes [A No
❑NA ❑NE
❑NA 0 N
❑ NA ❑ NE
C- omments {refeito gaestton• Explain any YES answers and/or'any additional recommendations -or any other comments.
Use drawings ofLfaeW to better explain situations (useFadditionmjpages ash
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1 of kil /7f /
- I f
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D Arrival Time: U11 0061#-W Departure Time: County: P540) Region:
Farm Name:1r ��-}-�SU)11j4 �M Owner Email:
Owner Name: ► ► `� n4or\ fir ►ti's Phone:
Mailing Address:
Physical Address: jj�
Facility Contact: gob Title:
fl
Onsite Representative:
Certified Operator: _j4r% R y � "`V't''}U,
Back-up Operator:
Phone No:
integrator res&�
Operator Certification Number: I(ao
Back-up Certification Number:
Location of Farm: Latitude: = = ="
Longitude: =0=, = "
J
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 U1 No ❑ NA ❑ NE
❑ Yes
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle C*apacity Populatiott
❑ Wean to Finish
10
Layer
Non -Layer
NA
❑Dai Cow
❑Dairy Calf
Wean to Feeder 17 WD 1 6 t{ 10
Feeder to Finish
D S 2
f� No
❑Dairy Heifer
Farrow to Wean
❑ Yes
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
ers Pullets
❑ ❑ Pullets
❑ Beef Stocker
10 Beef Feeder
❑ Beef Brood Cowi
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes U1 No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
(a NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
f� No
❑ NA
❑ NE
❑ Yes
1p No
❑ NA
EINE
Page 1 of 3 12128104 Continued

Facilify Number: Qg7qIDate
of Inspection x p a7
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Waste Collection & Treatment
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
55 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:
❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
asti ,,
Observed Freeboard (in): ZS
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[P No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[� No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
5 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Ep 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
M No
LP
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA ❑ NE
maintenance/improvement?
H. . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D No
❑ NA
❑ NE
„ s T P
(explain� (use add�houal� a es as necessa
Comments, refer to uestion.#). Explain an YES answers and/or an recommendations or anv other com
Use�drawm sof facility to better situaE�on
Reviewer/Inspector Name x ' Phone:
Reviewer/inspector Signature: Date: t O v O
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ERNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1� 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
(p No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[' No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31-
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PU 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
�q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EP No
❑ NA
EINE
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine 0 Complaint o Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:Q! Arrival Time: 3! 40 /w- Departure Time: 'tg0 County: S&Region:
Farm Name: ©Ir�Y� t� MBI .'—D s lUP1iA1 FdUwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: + Title: Phone No:
Onsite Representative:'-6g�s Ur-,� Integrator:
Certified Operator: i A4S Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1 ="
Longitude: E=l o =] , =11
Design Current
Design C•arrent
DesignFiat
Population
Wet Poultry
Capacity Population
I
I
Cattle Capacityn
❑ Dat Cow
❑ Dairy Calf
❑ NA
❑ Wean to Finish
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Wean to Feeder rl 1,M. 17 at
❑Non -La er I
Feeder to Finish
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
PNA
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
ElGilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ NE
❑ Turkeys
❑ Yes
Otber
❑ Turke Poults
❑ NE
❑ Other
❑ Other
NumSer of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
0 N
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�D NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
PNA
❑ 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
0 NA
❑ NE
2. is there evidence of a past discharge from any part of the operation'?
❑ Yes
PDNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ YesNo
ElNA
ElNE
other than from a discharge?
12128/04
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure IStnicture 2 Structure 3
Identifier: l� ► `
Spillway?:
Designed Freehoard (in):
n �
Observed Freeboard (in):
Stnicture 4
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No M NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �?No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
q No
❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ErNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E] Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) &AX&,rr►'t V06 Qat,Sht . n D
13. Soil type(s) Gres k)0aVZjWj I Decd, n
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
P No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
V No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
1P No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
4TNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
'�D 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 Phone:
ol
Reviewer/Inspector Signature.'Aha_
D 1 Date: /
Continued

s
r
Facility Number: — Date of Inspection
Reg uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[)jNo
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C§No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
'ONo
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
'A No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[PNo
`9No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128/04

4
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 24 Qg Arrival Time: !D010011 Departure Time: County: 54 ' —<do Region: AW
Farm Name: SWi'r'O PWM I rg �_ Owner Email:
Owner Name: 4tyf\ Phone:
Mailing Address:
Physical Address:
Facility Contact: `` Title:
Onsite Representative: �i+vtb
Certified Operator:
Back-up Operator:
Phone No:
Integrator:4t�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [:] o =' 0 Longitude: E�] o =' 0 «
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes )a No ❑ NA ❑ NE
❑ Yes
❑ No
04NA
❑ NE
❑ Yes
❑ No
(� NA
❑ NE
�tNA
❑ NE
❑ Yes
❑ No
❑ Yes
�gNo
❑ NA
❑ NE
❑ Yes
'9)No
❑ NA
❑ NE
12/28/04 Continued

r Facility Number: Date of Inspection�J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No PNA ❑ NE
Structur 1 J Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: --�r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes 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 �SNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesNo ElNA [:1NE
(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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ElNA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes & No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > I0% 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)
&Uss &&j), SM • 6'-O-, Xo v�e'
13. Soil type(s) •�ght^
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 10 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 f] No ❑ NA ❑ NE
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
77
Comments (refer to question #): Explain any YES answers and/or auy.recommendations or any other comments.
Use di i;wings of.faciilty tobetter explain situations.(use addttiodal pages as necessary):.€
Reviewer/Inspector Name �� bW Phone: 3 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 7212klW Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 N [INA ❑ 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
R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F) 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
E5 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tZ�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J&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
KjNo
❑ 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
IP No
❑ NA
EINE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
�jNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
FhNo
❑ NA
❑ NE
Additional[Gomments�and/or.,Dir awiogs - - - -
Page 3 of 3 12128104
Page 3 of 3 12128104

Division of Water Quality
Facility Number[�
V Division of Soil and Water Conservation __�j
Q Other Agency
Type of VisitCpompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitN* Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ^Arrival Time: Departure Time: top a County: Wh Region:
Farm Name: Ob ! hOt' h�� "`�Owner Email:
Owner Name: &J2 h-" Phone:
Mailing Address:
Pbysical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
fSWean to Feeder
fT Feeder to Finish
-
,E] Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Cilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = e F-1 = Longitude: = 0 0E__1 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
a+ ❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population`
❑ Dairy Cow R
❑ Dairy Calf
❑ Dairy Heifer
ET Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©i
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?
J
❑ Yes P
No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
[j4 NA
❑ NE
❑ Yes
❑ No
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
boNo
❑ NA
❑ NE
12/28/04 Continued

acility Number: Z,— 1 Date of Inspection
Waste Collection & Treatment
4. Is storage ca H (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes Wo ❑ NA ❑ NE
a. I w Ae level into the structural freeboard? ❑ Yes ❑ No INA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
de ' ier:
Spillway?:
Designed f=reeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ YesNo ❑ NA ElNE
through a waste management or closure plan? 10
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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
mai ntenance/improvement?
11
IE
❑ Yes No ❑ NA ❑ NE
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ►] No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) J
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi.
❑ Outside of Acceptable Crop Window l Evidence of Wind Drift �❑ Application Outside of Area
Crop typer—x-s) _fn..�! //✓ ►jyA
13. Soil type(s)
14. Do the receiving crops diffbr-from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
IP No
CS No
1N No
L'No
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):
❑NA [__1 NE
El NA [j NE
❑NA El NE
❑ NA ❑ NE
0 N ONE
❑ NA ❑ NE
Reviewerllnspector Nam K VJNE CzM/ Qf 4& r Phone:`I (U T 5S
Reviewer/Inspector Signature: Date: v2r
1212844 Continued

Facility Number;%z--Rfl Date of Inspection I "�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J� No ❑ NA ❑ NE
the appropirate box. ❑ VJJP ❑ CheckIists
❑ Design [:1 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yeso
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[IYesFN
o
El NA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit`?
El Yeso
❑ 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
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
l
30_
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
12/28/04

0
Type of Visit compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outing 0 Complaint 0 Follow up 0 Referral () Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: DepartureTime: County: Region:
FarmName: Owner Email:
�-NcuJ
Owner Name:ZS2 L2�a�'yti`Dw Phone:
Mailing Address: ?51 &4-iZ'__ ZI✓`&le _Xnavt
Physical Address: }}
Facility Contact: SI) b �Y rt`�`D Title:
Onsite Representative: _S
Certified Operator:
—
Back-up Operator:
Phone No:
Integrator:��A,c..
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e =. = Longitude: =0=1 = u
Design Current . Desigtt ..Current Design Current
Swine Capactty P,opIM, tton Wet Poultry Capacity Populahon Cattle Capacity Population
❑ Wean to Finish ❑ La er1-1 1 ❑Dairy Cow
® Wean to Feeder (v ❑ Non -Layer ❑Dairy Calf
Feeder to Finish e'o p s 7 W
w Dai
El
Heifer
ElFarrow to Wean D Cow
r;ryou:_❑Farrow to Feeder �; "� El Non -Dairy
w;
❑ Farrow to Finish ❑ Layers ❑ Beef Stocker
❑ Gilts ❑ Non -Layers ❑ Beef Feeder
El Pullets El Boars ❑ Beef Brood Cowl I
❑ Turkeys
Other ❑
Turkey Poults
❑ Other ❑ Other +Number of S#ruetures:
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
❑ Yes
CgNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
nNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
9 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
CANo
❑ NA
❑ NE
1 Is there evidence of a past discharge from any part of the operation?
❑ Yes
ANo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/18/04
Continued

Facility Number: — Date of Inspection
❑ Yes
V1 No
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[gNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: D A a7 D
❑ Yes
9No
Spillway?:
❑ NE
18. is there a lack of properly operating waste application equipment?
Designed Freeboard (in):
[1 No
❑ NA
Observed Freeboard (in):y�Jr ` iozb
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
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
JONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
4L 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
[1 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):
'' I
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 72/28/04 Continued

Facility Number: Date of Inspection L
❑ Yes
tZ No
❑ NA
❑ NE
Re uired Records & Documents
❑ Yes
CK No
❑ NA
❑ NE
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ yes
PffNo
❑ NA
EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J'No
[—INA
❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
I& No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tZ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CK No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 N
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
Cl 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
JRNo
❑ 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
EqNo
❑ 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
EffNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative'?
❑ Yes
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
J@ No
❑ NA
❑ NE
Page 3 of 3 I2128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 40Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility lumber Date of Visit: Time:
ro lot D erationaf Below Threshold
Permitted Certified ❑ Conditionally- Certified E3 Re•„istered Date Last Operated or Above Threshold:
Farm Name: El 01- len_ - w ;Ir? rbc .y, County: SGs,Tdr,
Owner Name: do b 7�0.-r77�r, Phone No: 17/y - --r7 Z/ - G r"1 41 _
Mailing Address: _ W, &0a ��n/d 1V
Facility Contact: Jo4h A0^n1o,j Title, Phone No:
Onsite Representative: T.4' 4 0t^{o Integrator: _ %�i Ps �a e,
Certified Operator: joAii2 7_4 Operator Certification Number:
Location of Farm:
wine ❑ Poultry ❑ cattle ❑ Horse Latitude a 4 " Longitude ' •
Design Current
Swine Cannrite Pnnnlatinn
❑-Wean to Feeder 7630-
eederto Finish d
❑ Farrow to Wean
❑ Farrov to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca ncity Population
❑ Laver I 1 10 Dairy
El Non -Lave: I I JE3 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons E LJ Subsurface Drains Present j L Lagoon Area 1LJS rav Field _4xea
Holding Ponds / Solid Traps -"w ❑ No Liquid Waste Management Svstem
Discharses & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes ,,, //
a o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other ,�,
a. If discharge is obsen ed, was the conveyance man-made? El Yes !Vivo
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes Ld�o
c. if discharge is observed. what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If ves. notify DWQ) ❑ Yes 040
2. Is there evidence of past discharge from any pan of the operation? ❑ yes 0,, 7v/o
3. Were there any adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑Yes L� N/o
WaEje 001lection & Treatment —//
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway E3 Yes 3- o
Structure 1 Structure 2 Structure 3 Structure 4 Structure ; Structure 6
ldentifier 104, '�2 O
Freeboard (inches): _ 9 % tl
05/03/01 Continued

. Facility Number: q—
Date of Inspection -J -o
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?
(I€ any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive PondingH❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [j Copper and/or Zinc
r rjj
12. Crop type �erm 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
0 This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes B -No
❑ Yes EWo-
❑ Yes 9 -NO'
❑ Yes �o-
❑ Yes [bio
❑ Yes [moo
❑ Yes MING -
❑ Yes E -M
❑ Yes B -Mo
❑ Yes 0446
❑ Yes EINo
❑ Yes 0-N6
❑ Yes &N6
❑ Yes ❑ No
❑ Yes Q -No-
❑ Yes SN'o
❑ Yes [W6
Comaieats {refer to'questta #jlnimYaswes m�, r caatr g
�Ose draw�S;of fare better �explau3 ons. (nse addrtignal pages as neccsSary) ❑Field COPY ❑Final Notes i a r
m
Ti111,16,e A,i� vul✓e on ��rF Pl�l+,p c /� �oybo.� /C7t'� wG•S
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a
9
fol p cv eg VU /✓C ,
r� TAor,77en %crf -5a,6.,e kP4le-V -/s r-rlvr�•�L! lc.9o:^ �v Mal 4'e p�4•�S
OA To �lElj� �STud�1h aV�A �J rc.SS Ccs✓ei
9
.
T
Nae �-
Reviewer Name6
ReviewerAkspector Signature: Date:
12112103 Continued

Facility Number: Date of Inspection Tc' L
.,
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists,ddesign,ma rs c.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
-'t33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping.for NPDES required fyrms needjmprovement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [j -W
❑ Yes E;No-
❑ Yes E -No
❑ Yes ❑-io
❑ Yes E3 -N -o
❑ Yes EgWo
❑ Yes ❑'90
❑ Yes ❑ No
❑ Yes B -No
[Flies ❑ No
❑ Yes 9N6
❑ Yes B-90
❑ Yes ONO
❑ Yes O -Mo
❑ Yes t❑446
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddittonal Coinmrnts and/or=;Drawtn $ a
......r_.^_at ?, _:%." _.:iii••.`
c�y 12 4,
Mr, /horn�en 3/GfIecl f-Aaf- ]� -e 4rtnvn�-s�v[��c slirt
//3
010,p -ie 'JL/ /���s �< �4s �lof 6e �� a GmPJ- .
t3 41 r7 le- /`G,f 4e, re(&rd elle,
1
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12112/03

w
Site Requires Immediate Attention:
Facility No. 5�2
DIVISION OF ENVIRORTNTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: '1995
Time: 1 L�
Farm Name/Owner:
Mailing Address: P 0 �JO'i U5 FQ.w " Grove-, r)c a 83ta(v
County: Sam r-)
Integrator. TOM Frgwss Phone; /O
On Site Representative: Do" N t e nnat cl Phone: 0
Physical Address/Location: S s
Type of Operation: Swine��h. Poultry battle
Design Capacity: S-7 &0 Number of Animals on Site: �Coa
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or NoAc al Freeboard: Wit. Inches
Was any seepage observed from the lagoon(s)? Yes o N Was any erosion observed? Yes or Fo
Is adequate land available for spray Yes No Is the cover crop adequate? Yes r No
Crop(s) being utilized: Baa �� cFM.A ��- �-5�` l':
Does the facility n:,eet SCS minimum setback criteria? 200 Feet from Dwel lingj_?(Yej or No
100 Feet from Wells? Yes r o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o(N)
Is animal waste discharged into waters o the state by man-made ditch, flushing system, or other
similar man-made devices? Yes" If Yes, Please Explain.
Does the facility maintain adequate waste management records (volums of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: r— S C•-
1 o,ct
• L� 4k_�
Inspector Narne
cc: Facility Assessment Unit
1 1 cQ _ Q W • C_V _
Signature
Use Attachments if Needed.
t

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATION
Department of Environment, Health and Natural Resources
Division of Environmental Management x
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217(c) in order to be
deemed permitted by DEM_ Please print clearly.
Farm Name ��;. !.J �_,. �,,SY TDM �'r y P_,I:l';,,_, IT -1 -
Mailing
— Mailing Address: Rt 1 Imo:- A i! L
Z i P
County:.- Phone No
1
Owner (s) Name: 5,_
manager (s) Name:
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc-) '� 7�r �S -5,:..X ��,� {! = :., !-r�..0.
Latitude/Longitude if known: (4'_C -SP
Design capacity of animal waste management system (Number and type
of confined animal(s)): Of � .N + - �,•,�;i,
Average animal population on the farm (Number and type of animal (s)
raised) 170, �z�� I=�t #v
Year Production Began: l i 5-_::Z ASCS Tract No.:
Type of Waste Management System Used:
Acres Available for Land AppliccaQti_on� of Waste:
Owner (s) Signature (s) : IAB LDATE__,?
DATE: