820072_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Com ante Inspection Operation Review Structure Evaluation p Technical Assistance
[lesson for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: / Arrival Time: Departure Time: County: 17i f W)
Farm Name: i t Hop tr, Owner Email:
Owner Name: ra,tu NG Phone:
Mailing Address:
Physical Address:
Region:�rjz[)
Facility Contact: Cil wT I S !, 4'Awt cff Title: Phone:
Onsite Representative: t� Integrator: - l� S
Certified Operator: eK4-1 Ce Cr, KvW 417 Certification Number: �6 Z
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
ONE"
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Capacity Pop.
Cattle16
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
4 t Q $ -
Dairy Heifer
Farrow to Wean
Desiign
Current
jDry Cow
Farrow to Feeder
Dr ]P,ouI
Ca sci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers.
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qtber-:
_
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D_NV--_❑ NA ❑ NE
❑ Yes ❑ No E3-IqX ❑ NE
❑ Yes ❑ No ❑ NE
❑ Yes
[:]No
[] Iq'A
❑ NE
[:]Yes
[3--go—
❑ NA
❑ NE
❑ Yes
D- o
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: Z Z Date of Ins eetion: .2`7
Waste Collection & Treatment -
4. I.4storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q'1qA' ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
I dentifier:
Spillway?:
Designed Freeboard (in): rj
Observed Freeboard (in):� Ip
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ 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
LJ"o
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
0 Yes
0--No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ffNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
El"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [r 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): C 113 L� � } l (Z t) 7 enseu -t
13. Soil Type(s): '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L'r '"o ❑ 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 ❑ Yes 2 ' ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes BIZ ❑ NA ❑ NE
❑ Yes Ea-3qo_ ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to
❑ 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
Ea<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
�
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - Z Date of lns ection: n(
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q-116— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 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 [i]'I o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�'�Io ❑ 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 [7No ❑ 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
[E o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[-} o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3-lTo^
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑-lVo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
1�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).
3, C�
l= 0
Reviewer/inspector Name: �� l
Reviewer/Inspector Signature:
Page 3 of 3
Phone:0
Date:
2/4/20 S

(Type of Visit: 0-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: QKRoutine O Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:' Region: r ►'P
Farm Name: �. � Ra titt, S' 3 Owner Email:
Owner Name: 4-L� Fes' 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: E'y�{S �q�zy� Title:
Onsite Representative: j I
Certified Operator: kw c c 'ret •e
Back-up Operator: ,
Location of Farm:
Latitude:
Phone:
Integrator: /# 6 - 5 _
Certification Number: %r,3,17
Certification Number:
Longitude:
�......
•
Design Currents.
n.
Des 'g
XF
ent Desi n Current
- g
Swine
Capacity PopWet;Poultry Capacit
VPRPCattle 11 r C►apacity Pop04.
Wean to Finish
La er
== Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
x
t{Ip pv � , ; �
Dairy Heifer
Farrow to Wean
-
- Design,
Current' D Cow
Farrow to Feeder
a
F<D Poa1 ry `°Ca acit
P.o k+. Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
- -
Ot1-
. ."
Turkev Poults
Other
UA
u
Other'
Dischar 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?
❑ Yes [—"❑ NA ❑ NE
❑ Yes ❑ No [t-NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
M NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (1fyes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[frNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facility Number: CAI- Z Date of ins eefton:
Waste Collection & Treatment
4tiIs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �ie­❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EEtIqX_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
•q��
Observed Freeboard (in): V 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
La'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
[8 Ro
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[aNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
nNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? 1f yes, check the appropriate box below. ❑Yes ❑ 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): �llt NI
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EBI }o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Er -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [TNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fl-No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
[!:rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[XNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[01�0
❑ 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. El Yes
�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E' No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: Z
24• Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
r- ❑'��
2$_ Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [�-iQo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ -'Nb ❑ 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 [�o ❑ NA ❑ NE
❑ Yes [:J'Ilo ❑ NA ❑ NE
❑ Yes ❑Ko ❑ NA ❑ NE
❑ Yes [3"No ❑ NA ❑ NE
❑ Yes ["No
❑ Yes �o
❑ Yes ZNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C<, l (or - t SI
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:gt _y _ qM 1 3 W
Date:
214 015

Type of Visit: /(>Compiiance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GrCoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Ua&Arrival Time: f� Departure Time: County:
Farm Name: � fEfd'1' -r,c �T Owner Email:
Owner Name: C t
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: _ _CGLi✓+13yt(k Title: Phone:
Onsite Representative: Integrator: I 13
Certified Operator: tvl v` Certification Number: —
Back -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design 'Current
N DesignCu'rrent
__ Design �nrrent
Swine
Cap ciity Pop.
Wet PAC Capacity`sCattle
Capacity Pop.
a
inish
Layer
DairyCow
Feeder
Non -La er
Da' Calf
Finish
L{
f
Da' Heifer
Wean
DesignCtirrent
D Cow
Feeder
EBoars
D , Poult Ca actty�Po .
Layers
Non -La ers
Non -Da'
Beef Stocker
Beef Feeder
Finish
Pullets
Turkeys
Beef Brood Cow
Other
TurkeyPouets
Other
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
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 DWQ)
❑ Yes
❑ No
�TA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E_N�
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[3 Yes
U No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - jDate of Inspection: ,f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3_bhL_E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑-i❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ]N ❑ 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 Ea_b� 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-?t❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3-Na ❑ 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 ❑Ycs []"1Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes G4'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 4o ❑ 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):
61V 0 r
G",",
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?
Re aired 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 B-W ❑ NA ❑ NE
❑ Yes [g-Now❑ NA ❑ NE
❑ Yes Q19O ❑ NA ❑ NE
❑ Yes to NA FINE
[:]Yes Ca No DNA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes F2-1`�o LJ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'No ❑ NA Lj 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 dNo ❑ NA ❑ NE
1
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes
the appropriate box(es) below_
❑ Failure to complete annual_sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
El-`6 ❑ NA ❑ NE
[-No ❑ NA ❑ NE
❑ Yes [❑ NA ❑ NE
[:]Yes [J-N6 ❑ NA ❑ NE
❑ Yes ❑r -1 o [3 NA ❑ NE
❑ Yes C]k.No ❑ NA ❑ NE
❑ Yes [3 11° ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L2-tgo'
❑ NA
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q-11o__❑
NA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I�C_7"'
❑ NA
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
Reviewer/Inspector Name:
W
Reviewer/Inspector Signature:
Page 3 of 3
3,1(5�
�'e o tf3 76
- /1
Phone: 13UL 11
Date: `� 1
21412014
❑ NE
❑ NE
❑ NE
❑ NE

Type of Visit: (6mol+ance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: RRoutine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
J (�
Date of Visit: Arrival Time: �� Departure Time: County: J j� Region:
Farm Name: -4 �SaVA,, Owner Email:
Owner Name: _ vi _ '— Phone:
Mailing Address:
Physical Address:
Facility Contact: C4A Title: Phone:
Onsite Representative: �� Integrator: q e
Certified Operator: g_o't_ C 4 Certification Number: 4 2V
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
f
Design Current �� = Design Current- Design Current
Swine
Capacity Pop*t"f Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Dairy Cow
Non -La er —Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
k ..,=:
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D . tiioultry Ca aci Po .' Non -Dairy
La ers Beef Stocker
Farrow to Finish
Gilts
Nan -La ers Beef Feeder
Pullets Beef Brood Cow
"•'. z,. Turke s -_
Boars
Other
Turkey Poults
Other
Other
Dischar es and Stream Impact
I. 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 [].Pd ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[]-N'A ❑ NE
❑N-E
[:]Yes
❑ No
[EJAA
❑ NE
❑ Yes
aeo
❑ NA
❑ NE
❑ Yes
E.?do
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is sto;0ge capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ZrNa__❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No E3-N*--E-] NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J CJ Y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg—Na— ❑ 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
E]4kr—o NA
❑ NE
waste management or closure plan?
JLjLny of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
00 any of the structures need maintenance or improvement'?
es
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[INT—❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
[2-1qo-__ ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Eq"1 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): '56V E--Y 4 c e
13. Soil Type(s): V_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P�❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EQ-N6'__❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
� ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
i..d o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]'1�10 ❑ NA
❑ NE
Re aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 3<0 [DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 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 []?4o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: W,,4 - 7ZI jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�E] NA ❑ NE
25. is facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [AlNcr- ❑ 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 ❑- -M ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [B-Ko_� 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
FD Ko- ❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EJ 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
[2,Kb�_ ❑ 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
Ej<o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[g.Xr, ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3-15—o ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other commenfs.
Usedrawings`of facility to'betie'r explain situations (use additional pages as necessary).
r
C&IlbV-Z�j )PV, G 41 - lam l
A 3-L7
l l�iVt N.�P✓li�� �D
o��tS� 0✓l
J
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
F.9� DOv� kk�'C -r�,°
k
o, �, 7
40
Date:
1?3
1

Lype of visor: �a ompnancc inspection V uperanon xeview V arrucrure Evatuarion V i ecnmcai Assistance I
Reason for Visit: O'goutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I Cn!(VAjnDeparture Time: 1,0 -7' County: 5nn
Farm Dame: Q1 (�'� H �jAtRm 3-s Owner Email:
Owner Name: _ Q �qA1-." 5 a nC Phone:
Mailing Address:
Physical Address:
Facility Contact: aApL�eTitle:
Onsite Representative:
Certified Operator: _ Qrptiin-�, cow
Back-up Operator:
Location of Farm:
Phone:
Region: R6
Integrator: MUR h �0U1f�
Certification Number: 153422
Certification Number:
Latitude: Longitude:
Current Destgn Current
Design Current
k�Destgn
o P•
CarteSwine Capacity Pop.
�
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
y\4
0
'_ fir; �r�r
,r Design Curren#
D ruylPoul . ,. Ca achy P,o .
Dairy Heifer
D Cow
Non -Dairy
Farrow to Weanf
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turkeys
Other
Turkex Poults
Other
o. •..
_ .
Other
... .�..::... � > ate:
. _....... .:
Dischar 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 �No ❑ NA ❑ NE
❑ Yes
❑ No
[90'RA
❑ NE
❑ Yes
❑ No
[2NA
0 NE
❑ Yes
[:]No
ER<A
❑ NE
❑ Yes
D"'No
❑ NA
❑ NE
[—]Yes
[R<o
❑ NA
[] NE
Page 1 of 3
21412011 Continued

lFacility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L�r`No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [VNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): �3 I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes�r`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 [TNo ❑ 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 ffNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [11No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes []"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes &No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): _ R r�vnA G R PZ� i 15+(�i . U f ` E SCUF. /'P4S4LJ eE J
13. Soil Type(s): lac.Rvl�m I\
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [v4No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0"'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [g�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [g"'No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ "No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [g(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ T to ❑ 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 [Ur"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 6/No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No EdNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: a - -7 jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CgrNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [OrNo ❑ 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 Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [ A ❑ 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 E3"No ❑ NA ❑ NE
❑ Yes [t"No ❑ NA ❑ NE
❑ Yes E�fNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA [D NE
❑ Yes [;]"'No
[:]Yes [No
[:]Yes GYNa
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: <Aetl Date: -c;h31
Page 3 of 3 21412011

,3in,,s -711V111 a764-
Type of Visit: j2rCom fiance 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: County: Region:
Farm Name: Owner Email:
Owner Name: �, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Kk_k% nsWo_ , Phone:
Onsite Representative: � Ih,4 _ Integrator:
Certified Operator: C?-; (naljnA Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design` Current
a Design Current✓
Design Current
Swi a Cap rty 'Pop.
Wet Poultry ,'- Capactty x Pop:
Cattle Capacity Pop.
La er
Dai Cow
Wean to Finish
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish:
Da Heifer
Farrow to Wean
a`DesignCitrrent
D Cow
Farrow to Feeder
Dt, P,o_uItr '`" �Caactty? r Po `
Non Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Pullets
err .h
Turkeys
Other `'
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ra<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
1 _I "A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[—]Yes
❑ No
02,1 A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
[::]Yes
[:]No
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[314
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Na o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

lFaci6 Number: jDate of Inspection:
Was* Collection & Treatment '
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E o
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: # I
Spillway?:
Designed Freeboard (in): /19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
�iA ❑ NE
Structure 5 Structure 6
❑ Yes Q-110 ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Z14o
❑ 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]oKo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g 1fo
0 NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EJ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E2'14o
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 5a 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 Are
12. Crop Type(s). �Gi�Y1i�', Lai'1`�'';e�� �c �(J'xJ LLc�, �f
13. Soil Type(s): , _Irw
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EJ�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E2-<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
to
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
to
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2<o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R2 110
❑ 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 21r. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes [:]No A ❑ NE
Page 2 of 3 21412011 Continued

Facility NuMber: - Date of Inspection:
24_ DFd the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U.❑ NA ❑ NE
�L
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes VNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No ❑ NA &<'
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes L j,<o ❑ NA ❑ NE
❑ Yes Ej o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ej No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes FRI10 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EKo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

e"-6.rc.L IO - o z - Zoo g
Facility Number
Or -Division of Water Quality
O Division of Soil and Water Conservation -
O Other Agency
Type of Visit
omp ante Inspection
O Operation Review Q Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up Referral 0 Emergency
Other ❑ Denied Access
Date of Visit: y- 23 'D 9 Arrival Time: �2.'3a Departure Time: /� : �` County: Region:
Farm Name: _ A . tl,-� Rz V'^^ 3- S- Owner Email:
Owner Name: A bY 64 ► M . Zr/C- • Phone:
Mailing Address:
Physical Address:
Facility Contact: wCULILi 3(Y1'W+'LK Title: / <`l ' L — Phone No:
Onsite Representative: Cu S b'E:+-�rr`cK Integrator:
TcV ' Z: art-e -d
Certified Operator: —_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number;
Latitude: = c 0,= Longitude: = e 0 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
W10
-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non-L
Pullets
jJ TurkeX Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity ;Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
h. Did the discharge reach waters of the State'? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. 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 L'1Na ❑ NA ❑ NE
❑ Yes
❑ No
[]<A
❑ NE
❑ Yes
❑ No
EM
❑ NE
l-T NA
❑ NE
❑ Yes
❑ No
❑ Yes
[J o
❑ NA
❑ NE
❑ Yes
DIN.
❑ NA
❑ NE
12128104 Continued

Facility Number: 2 — `] Date of Inspection 19' 23 O
Waste Collection & Treatment ,-�,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I�rvo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2-Ko ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
a
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 8iOU— ❑ NA [_1 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [4Ie---E] 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 EHTo— ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E-Nv—­❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q;Xe NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? ,_,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 21<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 ❑rApplication Outside of Area jj11
12. Croptype(s) 9e.r.�....�kc.J SA4AiC
13. Soil type(s)
U
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
❑ Yes
❑ Yes
�fo ❑ NA
No ❑ NA
No ❑ NA
No ❑ NA
8<0 ❑ NA
Phone: Ct io.
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Y
Reviewer/Inspector Signature:
Page 2 of 3
Date: 9 2 3 -- ? O0 `l
12128104 Continued

�_Z3_ ay
Facility Number: $Z — 7 Date of Inspection
Re . dR d &D t
wre ecor s ocumen s
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
21 o ❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
l!J'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
i oo ElNA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El2 Yes
o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B7 o❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
[IYes
[3-Koff❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑'1Vo ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0'No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETo
❑ 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
B<o
❑ 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
[K.'
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�,7/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L�'No�No
❑
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L#❑ NA
❑ NE
12128104

ivision of «'ater Quality
IFaCiI>E#y Number S % Division of Soil and Water Conservation
Q Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ` / Departure Time: '/Oqr.� County: sp```�SO� Region:
Farm Name: A.D.37 cAk-w% - '-5 Owner Email:
Owner Name: A b J_ a vH,t Phone:
Mailing Address:
Physical Address:
Facility Contact: l'.1 41`, Title: 7 <__. / SLAG Phone No:
Onsite Representative: Integrator: Cd i�a V. C- fQ V" "
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e = 1 ❑ i! Longitude: = 0 0 i =
Design
Current Design
Current
Design Current
Swine
Capacity
Populat on Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -La er
I
Dairy Calf
�6 D -..
eeder to Finish4;-410 La c
El Dairy Heifer
❑ Farrow to Wean
�-Dr}����Poultry
El D Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
' ❑ Turkey Puults
10 Other
_:::jNumber
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

f +
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 7 2,7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes O o ❑ NA ❑ NE
❑ Yes EL Ko ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [R o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, 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 �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 El Yes LfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 09 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 Area
12. Crop type(s)
13. Soil type(s) Wat �p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination `? ❑ Yes LY oN❑ NA ElNE
3
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 B No ❑ NA ❑ NE
Reviewer/Inspector Name �e�/e_lPhone: Ft'd • f4-3.3.320 6
Reviewer/Inspector Signature: Date: Z-03— ZU/O
12128104 Continued

Y �
Facility Number: g2 — 7 Z Date of Inspection -/O
Reauired 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 No ❑ NA ❑ NE
❑ Yes SNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
l _'J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
L7 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
FNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
No
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
3 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
12128104

Type of Visit C-tCo-impliance Inspection O Operation Review O Structure Evaluation V Technical Assistance
Reason for Visit Orfroulne 0 Complaint 0 Fallow up 0 Referral 0 Emergency O Other [I Denied Access
Date of Visit: $-Z/- D 8 Arrival Time: Departure Time: County: So...y-rdv Region:
Farm Name: /` DJ 1402 f ayA"i 3 -j' Owner Email:
Owner Name: RbJ— Fa v 1-ti4 Phone:
Mailing Address:
Physical Address:
Facility Contact: CujfiS
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =] e E=I ' 1=1 Longitude: = o = 6 = Ii
.i III
Design @,urrent +�
Design Current* Design Current
Swine-
Wet Poultry
CapaityPopuladon` .�,...W...u�� ���
Capacity Population k (Zattle� Capacity Population
❑ Wean to Finish
�. ❑ Layer
„_.
El Dairy Cow
❑ Wean to Feeder
❑Non -La er
Dairy Calf
El Feeder to Finish/0Z
9 - ❑ Dai Heifer
❑ Farrow to Wean
Dry Pouttry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
El
La
Layers
El Non-Laers
El Puklets
El Turkeys
Turkey Poults
Other
❑
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [I Yes LJ No [-INA❑ NE
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made'? El Yes ❑ No Ll tvA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes El No �A ❑ 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 lJ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes L��, N[-Ioo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElET
Yes No NA El NE
other than from a discharge?
Page 1 of 3 12128104 Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [I Yes LJ No [-INA❑ NE
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made'? El Yes ❑ No Ll tvA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes El No �A ❑ 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 lJ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes L��, N[-Ioo ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElET
Yes No NA El NE
other than from a discharge?
Page 1 of 3 12128104 Continued

Facility Number: $Z— Z Date of Inspection _2 rp
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �dNo El NA [I NE
a. If yes, is waste level into the structural freeboard? ❑ Yes I� No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25 ,/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,/
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 3 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CrNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Relw"Idla�, G:��L�� S;ualf G f�v_<o,5. Ze_scu�
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[� Two ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[Ko ❑ NA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
3 ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
E oo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
ET o ❑ NA
❑ NE
a cScl Coca :�a�S �
Reviewer/inspector Name Phone 2/0, V33 , 3�3�7
Reviewer/Inspector Signature: /Cea Date: V Z/ — Cid f
Page 2 of 3 12/28104 Continued

Facility Number: SZ —7 Z Date of Inspection
Required Records & Documents ,,.�,,5� ❑
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �L'flo ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes L1 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Rlgoo ❑ 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
Q'EVo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EM ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
3'TTo— ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[T%o— ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[,_�-Tq-o El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElB Yes
o ❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [317D ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D<
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,��
L`7nro
❑ 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
L7 No
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative`?
El yes
��
o❑
NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
,Eh
L7Noff❑ NA
❑ NE
Page 3 of 3 12128104

• 1.
® Division of Water Quality
Facility Number gZ 7Z 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /D-/O�/T-��7 Arrival Time: / ' ZS' �{ Departure Time: /; /S- County: S� �+-ASrh �
Region: Z
t1�.L ] Farm Name: Ila Owner Email:
Owner Name: IJ 2 l✓a ✓j'� "� Phone:
Mailing Address:
Physical Address:
Facility Contact: C�✓� S ���"1i'`� Title: 4Nv. ,,"fee Phone No:
Onsite Representative: _ ra itAls Hark! c_ Integrator: .,. �7 �� }'/ e—
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 6 = Longitude: = ° [--] , 0 u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La n
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Q
Q
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
.Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Discharges & Stream impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dai Cow
❑
Pair Calf
❑
Dair
y Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
?No
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

A
Facility Number: `3Z — 7Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
fVNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[j No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
❑ NA
❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[� No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Area
12. Crop type(s) M Ko s� .
C�Scu f- G,.:. e
13. Soil type(s) t4'las
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
1� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
L-3e_(A h."Q{0.14 11(_< -
ReviewerAnspector Name Phone: 210, V33, 3D4
Reviewer/Inspector Signature: u--•--L� Date:
12128104 Continued

Facility Number: fZ —']Z 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EP 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[� No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P 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
[�j No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
§F 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
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /Z.'30 , Departure Time: County: 4n fo-1 Region: `cA'0
Farm Name: A A Ea rn^ s Owner Email:
Owner Name: i±o.j x Id Ca,c,,.r a,ci� -'t We,A/ Phone:
Mailing Address: /36-4, 8c+�S_S__ r'. o V-, ` RcL , R o 5 , 1.0, a 0 NC -
Physical Address:
Facility Contact:
Title:
Onsite Representative: Cu r4%S E rk"—w f r_ k_
Certified Operator: Ra
Back-up Operator:
Location of Farm:
Phone No:
Integrator: Co sari __
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ I = Longitude: = o ❑ 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish XH10 Z 5
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other `
❑ La er
❑ 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 "'
Capacity Population:.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Dumber of Structures:
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
M No
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
12128104 Continued

Facility Number: $Z-1 Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D9 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f 9
Observed Freeboard (in): �7Fs
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
C9 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
C@ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
A No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [-]Yes
ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes
No
❑ NA ❑ NE
maintenance/improvement?
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
®No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)--
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Ej No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination❑ Yes
[g'No
❑ NA
❑ NE
17.
Does the facility tack adequate acreage for land application?
❑ Yes
[3No
❑ NA
❑ NE
18_
Is there a lack of properly operating waste application equipment?
❑ Yes
[$No
❑ NA
❑ NE
Comments (refer.to question f. Ex&tin-any YES answers and/or any recpmmeeidations.or any -other comiinents.
Use drawings of facility to hetter.ezplain situations. (use additional pages as necessary):' r° "
Reviewer/Inspector Name FR C �( erl l t S. Phone•69/0/ �$(y %5;��
Reviewer/Inspector Signature: Rrc,Z� Date: S-OS - zag
12128104 Continued

i
Facility Number: 52 --1Z Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ZNo ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5a No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[g No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RfNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 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?
El Yes
,,-++��
LA No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
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/]nspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Coinments;aii or Drawings: 7 `;
�.
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CP Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: a� y-S� Departure Time: County: .sa t sau Region: FIZZ
Farm Name: /9QOwner Email:
Owner Name: _onQ�� �annx�y _ �4�� War rc r. Phone: —910 S G �i — L .:2a-Z
Mailing Address: 34/_C_ 06�111 �� � %CoP /Pa 1t6Z'r 5
Physical Address: -_ _dga�s Lo_-e__
Facility Contact:
Title:
Onsite Representative: tt� 3Qta.4 is -
Certified Operator: a_o>> a ti.- C 4".' ..Qu
Back-up Operator:
Phone No:
integrator: C12A.,,L_
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = Longitude: E—_1 o 0 , 0 «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other v
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ej
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current .
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Dumber of Structures: �!
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Il'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 Li No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
❑Yes
❑No
❑ Yes
W1 No
❑ NA
❑ NE
❑ Yes
Q9 No
❑ NA
❑ NE
12128104 Continued

J
r •
Facility Number: 2— 'f Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:f`t`�""
Spillway?:
Designed Freeboard (in): = 9, ,2
Observed Freeboard (in): -..c2 6 F
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes [ANo ❑NA ❑NE
El Yes UNo El NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes [4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 91 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:)PAN ❑ PAN > 10% or I0 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 types) Fes ececzt�
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
q 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
(9 No
❑ NA
❑ NE
{— L Or JL a,oJ a fir+oO�c1
d`�e_ rr" rs -
Reviewer/Inspector Name l Phone: 7 I6 `f-fe- -- �Sy�
Reviewer/Inspector Signature: Date: 3 / I G �5S
I2128104 Continued

Facility Number: So? — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [1 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.
❑ WTJP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R 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
N No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
m No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
[4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Apio�,� ,"'^ti i a-«s ;rc.:.C.*,k--k �%.� spI i sV_- 6--121r--k,
F 0FIL wI-Vo+ s CA ✓ e_ck la {
1 T f S G v crrG.Q G
12128104

(Type of Visit QrCompliance inspection O Operation Review O Lagoon Evaluation I
'Reason for Visit 04outine Q Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Elate of Visit: EMM Time- �
Q Na Operational Q Below Threshold
permitted 13-tertified [3 Conditionally Certified © Registered Date Last Operated or Above Thr hold: ...... ---.--. ..
Farm Name:.......................................................... County: ... ......
•__ ._ .
Owner Name: /`fiwRrf�: LAA41� �`�'t..._t!!lC1C!r .......... Phone No:.....�r...._�!�`..-- ...... t . --------- - -,.
Flailing Address:.- � 3•k�—r--/aaS.�...�!l�L ._.�.� __ . .... ......._... _.....f
Facility Contact: �ri`t Chh ...................... -Title:e _ ------ .. Phone No: ....„..
Onsite Representative:--•&vS ..... Frw1`,t �._. ��....�.--------- Integrator: 0 f;r-
Certified Operator:__......b�il4 ��......... �a - .W .. Operator Certification
Location of Farm:
MoSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ���
Swine
Desgn
Current to Feeder ;`: ❑ Layer
er to Finishow
to Wean
r
w to Feeder
w to Finish
Gilts
Boars
urrent lt)es>tC
Other
Total Desigt>iCa cityTotal:SSLW
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
YesYes ❑ No
Yes ❑ No
Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Rgo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M<O
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �l�Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............1--------
Freeboard (inches):12112103 Continued

Facility Number: Date of Inspection f �lf7'll
~ 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[' o"
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
2Vo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement"
❑ Yes
Pf4o
8. Does any part of the waste management system other than waste structures require maintenance!improvement?
❑ Yes
Ej-no
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
GKO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
[I Yes
[yjo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[i],Ko
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type L848,1 II -M t^V
13. Do the receiving crops differ with thele designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Pgo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[f io
b) Does the facility need a wettable acre determination?
❑ Yes
214o
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15. Does the receiving crop need improvement?
❑ Yes
Q'rNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
[40
Odor I_tisues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
[ Ro
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
r❑&
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Mfio
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
[+10
Air Quality representative immediately.
... ... .. - ... - '.' .4 ..°- ='-h. - ­ .?* �."
Comments {re%rgtnon}"Ezplam aayYFs answers andler any�recam�eada3tons or`any other oornents t
Use drawtags of faeihty to hirttter expl setnah,{ase addlie na1 pages as necc=0)f�1d Co PY ❑ Final Notes
w
x �>
- key e i& V 4 �P ISs &A 5o4., 645.
A�jr t.t js .*Jvwrj
jrral r-i IJ S 6at 6 ti!'h Ltd &0" and lock�
w*�c�S L-4 ^4
ReviewerAnspector Name ='
Reviewer/Inspector Signature:
2
Date: 5� 1y 04
12112103 Continued

Facility Number: jj';t, Date of Inspection 5 0
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/ WUP, checklists, design, maps, etc.)
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?
33. 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 forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After l " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 2!�o
❑ Yes R o
❑ Yes R<o
❑ Yes 5M
❑ Yes 2'No
❑ Yes G?No
❑ Yes Gkgo
❑ Yes 2 No
❑ Yes [?'No
(yYes ❑ No
❑ Yes [no
❑ Yes [rNO
❑ Yes B No
❑ Yes &No
❑ Yes RrNo
12112103

Site Requires Immediate Attention:. -
Facility No. _ -7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: U , 1995
Time: �)
Farm Name/Owner: A a Fir j2_e0 - -
Mailing Address: & d J &_. /Y �; �' l;y 5 C: cf 3 6- Q _
County: 6, -R�s�-, - - -
Integrator:!_. - C, U,G Phone:_ J_ b V b
On Site Representative: r Jh , c Phone:
Physical Address/Location: P eG
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity:. Ste. ��� Number of Animals on Site: _ "e A
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: Longitude: 0 '
sp
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) 0 or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:-C pI�,4C4 I_ t3P � - S �,,� i� _ �rti,�� �� + c be
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? De or No
100 Feet from Wells? (9 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or Noo
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? �eDs or No
Additional Comments:
k�L (�;� -
Inspector NariW-
Signature
f
ra
cc: Facility Assessment Unit Use Attachments if Needed.

R a
J �
' Site Requires Immediate Atten€ion:. At
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT /V,-Z-
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 26, 1995
Time:
Farm Name/Owner:
Mailing Address:,
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' �* Longitude: ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) Gor No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: &*fir.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinl &e0or No
100 Feet from Wells? D
orNo
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oroNo
Is animal waste discharged into water of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes or6o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

FLEGIST2RATION FOE-^ FOR ANIMAL DL0T OPERATIONS
Departmenc of Environment, Health and Natural Resources
Division of Environmental Management
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 sheen, or 30,000 birds t;at are served by
a liquid waste System, then z.his form must to filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2t .0217 (c) in order to be
deemed permitted by DES!. Please print clearly.
Farm Name: /� / J //G �j ��C1 r' 7� - - AG%r-r 3
Mailing Address:
Count y :
Owner (s) Name: ve-cv �G1fi�/�v� �.L�� t' d ,/r'%i` /J�rfs.✓
Manage_ (s) Name: ;4A f
Lessee Name: V,a-,x-(
Farm Location (Be s spec.ir•�- as pgssib
milepost etc . }�jr/.�ti c� ///Ij s/
VZ/'. Alam r•,, arfi
road names, direction,
Latitude/Longitude if known:�_
/� y - !� U'J,,,`"' [�; • as .�
Design capacity of animal waste manag�nent system (Number and type
of cona_ned animal ( s ) ) fi�?T �0- M ��/sa Ac�4 —
Avera e an ial population on the farm (Number and type of animal (s)
raised) .. t _ yjzo eel
Year Production Began :4_2k/22 ASCS Tract No.
Type of Waste Management System Used:
Acres Available for Land Application f Wast 3S -
Owner (s) S 4 �natu_�e _{ s }
ATE.' 3-1 9 -7
-fa4e- do y (Nest o-F Cl. r rc� o?. 5 � �es . %/�•-, ��' ��
pX t 5 oZ

REGISTRATION FORM FOR ANIMAL FQQLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
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 hailed
by December 31, 1993 pursuant to
15A NCAC 24.0217 (c)
in order to
be
deemed permitted by OEM. Please
print clearly.
Fa rm Name: //• ,U •� //_�'C ,� �i Ul� F'
Mailing Address: 11,61'
County:
Phone No.
Owner (s) Name: /JYrc.- J vrf-� / nrr-i
Manager (s) Name _ 701 .
Lessee Name `QV;W-e
Farm Location (Be as specific- as possible: road names, dirtior�,
milj=�Z)ost, et .) : ,1iw k-Z-- C." /�/CJj/ W -- /,)eT-� , Yf
C y+• 7; OG 1309, A", v s '1~/t 1'2Oocl ge, % 7. ' 1
Lazitude/Longitude if known:
f 1y
1
Design capacity of animal waste management system (Number an type
cf confined animal (s))
Average animal porpulation on thefarm(Number and type of animal (s)
•raised)
Year Production Began :/U a7CF�r ASCs Tract No. .lC_�' d
Type of Waste Management System Used:•y�_
Acres Available for Land Application of Ware: 3�
Owner (s) Signature (s)
F

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Site Requires Immediate Attention: -
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1"5
Time:
Farm Name/Owner:_ _ -�} , T t - - Y - 3-J - - -
Mailing Address:
County: . 04 to _
Integrator: _ — - - _Phone:
On Site Representative: Phone:_
Physical Address/Location:
Type of Operation: Swine __�f Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit - Use Attachments if Needed.

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