820083_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua'

I n 0 c I
ivisioa of Water Resources
Facility Number 5 Z - © Division of Soil and Water Conserva
0tion
Other Agency I M
Type of Visit: CRompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: i y Departure Time: / County: 0f pr oto
Farm Name: sctl # � � yr G�d � l d� ' '� d� Owttr-ner Email:
Owner Name: ;SGo At c`, , L Phone:
Mailing Address:
Physical Address: �!
Facility Contact: U V4 " d a` 1U Nu 1 Title: Phone:
Region:
Onsite Representative: I`t Integrator: L{ 6-15,
Certified Operator: Certification Number: 5zK37
— ,V
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
TON bd
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, Pout.
Ga aci
Po P.
Non -Dairy
Farrow to Finish
Ell
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Broad Cow
ler
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
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 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—?4 o ❑ NA ❑ NE
❑ Yes
❑ No
[3"RA-
❑ NE
[:]Yes
[—]No
[31A
❑ NE
❑ Yes
[] No
E3 A
❑ NE
❑ Yes
[3-N
[] NA
❑ NE
❑ Yes
E rNo
❑ NA
[] NE
n,...a r nr z 7id/2n11; r,. fins.od

Facility Number: - Date of Inspection: S J,.
Waste_Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [j'No ❑ NA ❑ NE
a,I
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E lvA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z3 Z S 3 S 2-7
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes EEF-Ko ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes L ❑ 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
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
Q-No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EfNo ❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
Q"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): (2 n
13. Soil Type(s): d
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[(`�lo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E]No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2'Ro
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®'No
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EE
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ETNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

[Facility Number: jDate of Inspection: L1A1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �i ❑ NA ❑ NE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ .Mo ❑ 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 [�'1 oo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej ' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑Yes
❑-N0
❑ 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
[f].W
❑ 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
Ea No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ bia
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F I_000
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
[D-I o
❑ NA
❑ NE
Comments refer to uestion E- lain an YES answers and/uran add�h al.recodendatibns o"
( 9 #) xP Y Y,Y any other comments.
Use drawin s ohM-Cilito better a lain situations use addal= itionpages;;as, nec_essary).
L of I b a l o 1 i i` 6- l {a
J �'.c'r�'y L sCF J'tr �t �1 f "l 7
3 7
� C'
3.3
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
Phone:T(O-' y 3
re: Date: J t141 O
21412015

hype of Visit: 0 Compliance Inspection V Operation Review {> Structure Evaluation {> Technical Assistance
Reason for Visit: �outine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
f it
Date of Visit: ri�fj Arrival Time: 9 Departure Time: c(� County: _s_ Region:
Farm Name: ©.� �[ � ixc _
Owner Name: ,,,# %jy,=,&VL4_6
Mailing Address:
Physical Address:
Facility Contact: / 11� S 13ae-tt AL , Title:
Onsite Representative:
Certified Operator: lug"
"
Sack -up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: � '� 's
Certification Number: e?
Certification Number:
Longitude:
Design Current
Design
Current
. Design Current
Swine
Capacity Pop.
-Wet Poultry` CWapacit'.
Pop
Cattle Capacity Pop.
Wean to Finish
�
Layer
Feeder to Finish
Ov — -
Farrow to Wean
,-
Design
Current
Farrow to Feeder
Dr, P,ouItr * Ca 'aci •
Po
Farrow to Finish
_
Gilts
-
Boars
;..
Other
Other
�*
Wean to Feeder
Non -La er
La ers
Non -La rers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El 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 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'?
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Caw
❑ Yes 0� ❑ NA ❑ NE
❑ Yes ❑ No [�-i<7A ❑ NE
❑ Yes ❑ No [� NA ❑ NE
❑ Yes
❑ No
EfNA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page 1 of 3 1/4/20I5 Continued

Fac Number: Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes-
❑ NA
❑ NE
a. Ifyes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q-NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):---
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
g-Ko
❑ 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
[:j"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
,EI—No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 2!rNo ❑ NA ❑ NE
[a 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 Q ❑ Evidence of Wind Drift ❑ Appliiccatiion Outside of Approved Area
12. Crop Type(s):q.,eVWAtLJ6 Q ��-t/� - -
t3. Soil Type(s): 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [D-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []-N�a ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ED-No ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
19. Did the facility fait to have the Certificate of Coverage & Permit readily available? ❑ Yes n—No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �a ❑ 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 ;ZfNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fscility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the pemvt? ❑ Yes [3--No—
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yeso
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 F-144'o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [;�1Vo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes [D-No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E]�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [] No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes E:rNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [ o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E�I`No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes b No ❑ 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).
C04A r b -'1
4
/0
1 � e
Let 77
3,�
3,2
c,4 `I b _.
Reviewerllnspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
PhonAlo V-3-3
Date:
21412015

Type of Visit: O�C6mpliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 2 outine 0 Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:/�
Farm Name: u b L(e- . �G Owner Email:
Owner Name: S� Phone:
Mailing Address:
Physical Address:
Facility Contact: f L Title: Phone:
Onsite Representative: Integrator: lu (3 S
Certified Operator: „^` u[ e Certification Number: 15 7 Zf
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
-; Design Current
Design Cnrrent
Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Finish
rHfFeeEder
La er
DairyCow
Feeder
Non -La er
DairyCalf
o Finish 7
Dairy Heifer
Farrow to Wean i
Design Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Co —
Turkeys
Other
Turkey Poults
Other
I 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
1 Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes I_`_ o ❑ NA ❑ NE
❑ Yes
❑ No
�A
❑ NE
❑ Yes
[:]No
fNA
❑ NE
❑ Yes
[:]No
E!rNA
❑ NE
❑ Yes
E"Ho
❑ NA
❑ NE
❑ Yes
n No
❑ NA
❑ NE
Page I of 3
21412011 Continued
r,

Facili Number: - Date of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): {? � 3^16
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J '
❑ 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
[3-110
❑ 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
T Do any of the structures need maintenance or improvement?
❑ Yes
EJ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[A-Nlo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[}#o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3-go
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3"N-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 C1ro_p, Window ❑ Evidence of Wind D 1:1 �Ap`plication Outside of
Approved Area
12. Crop Type(s): ib 6A ? t 0 " Z e � AIL I ``Y e G `r`.1-.
13. Soil Type(s):. _U&J9 U _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [7!No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes e No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes E4�o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [d No ❑ NA [] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes []3'Ro 0 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E;?-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 ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412014 Continued

Facility Number: Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L_I ' " ❑ NA ❑ NE
t
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 13-55- ❑ 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 [3-Ko ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes ETNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2-�o ❑ NA ❑ NE
Comments {refer to questEon #} 4Eaiplai.wany YES answers and/or any additional recommendations or any other comments;' f
Use, drawtngs:of facility to better explam:situations (use additional pages as necessary). f `max
�S�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes �o ❑ NA ❑ NE
❑ Yes Ej.-No ❑ NA ❑ NE
❑ Yes [D-No ❑ NA ❑ NE
[-]Yes 0'&o ❑ NA ❑ NE
Phone: "f3
Date:
21412 06

A ype of Visit: (Q,"p I* nee Inspection U Operation Review U Structure Evaluation U 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: f LCounty:,. 'SS�vYl
Farm Name i 1) CA ce 4 6�_ Owner Email:
Owner Name: SlA ' I�C�vr� b �y�a��Cl�,� W_(11b Phone:
Mailing Address:
Physical Address:
Region: L� k�
Facility Contact: avJ(5 L7?L:�?Ul{tAA Title: Phone:
Onsite Representative: l Integrator: f -9
Certified Operator: # eco t.i XA�t �� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current - Design Current
Swine Ca aci Po Wet Ponl p '. W •
P t3' P• trY... papacity Pap 1' Cattle Capacity Pop.
Wean to Finish La er `''� DairyCow
Wean to Feeder Non -La er A • DairyCalf
Feeder to Finish ap - DairyHeifer
Farrow to Wean Design�C 'Trent D Cow
Farrow to Feeder D . Poul Ca a ePo Non -Dal
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other - _ Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [] NE
❑ Yes
❑ No
�
❑ NE
[:]Yes
[D No
[]-T�A
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
❑ Yes 0-No
[:]Yes ED-No
[/ "NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of inspection: ✓
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0_No--­O NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [EJ-11�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): < < (p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes '1 i�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� 1 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q'I o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
lT "o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 43"" ❑ 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): �cTvLi t t Q cs C. O (((--e c— bd
13. Soil Type(s). 8 l r �>r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ed o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EaAo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eq'fio
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑',Ro
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
["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 ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes [%'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

A
Facility Number: - Date of inspection: c!
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EBINo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rLD�'o [DNA ❑ 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 [T No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 B<o ❑ NA ❑ NE
❑ Yes El -No
[:]Yes [] No
[:]Yes [rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes FZNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E� No [] NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

Type of Visit: ��,, mpliance Inspection Operation Review p Structure Evaluation O Technical Assistance
('
Reason for Visit: Koutine O Complaint O Follow-up Q Referral O Emergency p Other O Denied Access �7
Date of Visit: Arrival Time: ii l w Departure Time: County: Region?:M­y
Farm Name: �Q� t? �^ Owner Email:
Owner Name: M ,cc K ct •-r-t W T— a k• U Phone:
Mailing Address:
Physical Address:
Facility Contact: L j h r c - k.a� ^! Title: Phone:
Onsite Representative:
Certified Operator: %C.
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
"Cu'rreat,
Design Current d
Design Desi Current
Swine
Capacity Pop ,X W Pouitry
Capac�ty� 1'op Capacity Pop.
Wean to Finish
,` yCattl
Y ]Layer DairyCow
We
We an to
La er
x DairyCalf
Feeder to Finish
won
-
DairyHeifer
Farrow to Wean
Design Coirent��Dry Cow
Farrow to Feeder
�Drv�. �_ • P-,uul
►a act Po Non -Dairy
C
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
NOOther
urkey Poults!
`
Other
FTOther
Discha es and Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
ET<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[t] No
[g-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[] N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
El ''q'o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

facility Number: 11 ,/� - ()U Q }j jDate of Inspection: j i 1111A /
r'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes []j4N6-�_[j 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 R3-XV�_❑ 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
❑ Yeses❑
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
rjjX6__ ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
D 1"' ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O o ❑ NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
JOutside of Approved Area
12. Crop Type(s): &> -
WA-C&' `� cj o co 111
13. Soil Type(s): W lt.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WL1P ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA r] NE
❑ NA NE
Page 2 of 3 21412011 Continued

4-
Facility Number: - CATA jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 10 ❑ 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 Eal ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [31. o ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E�Xo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E]l 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 C2db ❑ 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
[24o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
]o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does facility follow-up
❑ Yes
Yes
[!No
iWo
❑ NA
NA
❑ NE
NE
the require a visit by the same agency?
❑
❑
❑
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any, other; comments .T=
U'se df'awings of facilityWto, titter explain situations (use additional pages as necessary).
c
Reviewer/Inspector Name: )3 X ) \
Reviewer/Inspector Signature:
Date: f t9AA r
Page 3 of 3 1 21412011

7P1L( %Sl%
� ;Divvision of Water Quality
MRumber - O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: qXompliance 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: Op Departure Time: Countyt (v Cit
Farm Name: Ai^ p �Owner Email:
r
Owner Name: Q Phone:
Mailing Address:
Physical Address:
Regio?'-- f_
Facility Contact: n (I,� p Title: �itily Phone:
Onsite Representative: !� Integrator: I „ 4 — F
Certified Operator: ] _ D Certification Number: A72,
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
�� Desiga Current Desigu Current Design Current
Swine Ca aci 1'0 _.WetPou t Ca aci Po ir.; Cat#le
r ry p ty p Capacity Pop.
Wean to Finish Layer DairyCow
Wean to Feeder Non -La er DairyCalf
Feeder to Finish DairyHeifer
Farrow to Wean a" Design Current'`' D Cow
�.
Farrow to Feeder �-3yD Pouli" Ca aci Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts s Non -Layers Beef Feeder
Boars Pu]]ets Beef Brood Cow
£-
= Turkeys
Other � Turkey Pouits
Other Other
Discharges and Stream Impact
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes EK0 ❑ NA ❑ NE
[—]Yes [:]No
❑ Yes ❑ No
k;J- A ❑ NE
2 5A ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No F,�A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes �o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes <o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

! a
1Facifi Number: - jDate of Ins ectio
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z �]
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
dNo ❑ NA ❑ NE
E No ❑ NA ❑ NE
Structure 6
❑ Yes [E]-No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ENo
❑ 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
ErN- o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[gNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
02"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9'No
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): t_ k.> B (:� 13e.,- S-6 o
/4cl f E-
13. Soil Type(s): No e> 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E3"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ED"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [—]Yes ®'No ❑ NA NE
18. Is there a lack of properly operating waste application equipment? [—]Yes dNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA D NE
the appropriate box.
❑WUP ❑Checklists D Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 10 ❑ 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 1�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑'No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1 �
Facility Number: _ Date of Ins ection• "i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [R<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes RFlo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej iVo ❑ NA ❑ NE
Other Issues
29. 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?
Co l64, ( L,
cb.'A f
Reviewer/Inspector Name:
a
❑ Yes [11,No ❑ NA ❑ NE
❑ Yes [rN-o ❑ NA ❑ NE
❑ Yes ' �o ❑ NA ❑ NE
[:]Yes [" No ❑ NA ❑ NE
❑ Yes l rJ 'No
❑ Yes E o
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
XMxC42
Reviewer/Inspector Signature: Date: A_�_
Page 3 of 3 21412011

��M� 0-v1
i 'pv Vi w.a. K.1 l..VlLt/ii7iu4"C lilJpC�uVu L! l3perxuvw xev.cw v oiru VZiurC r.,vaiUanoo �j 1CCLllII'2ll H.131.11u111C
Reason for Visit_ (9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other t) Denied Access
Date of Visit: Arrival Time: ., S Departure Time: a" Q County:
Farm Name: c ' 4 OCQ � ��j Owner Email:
Owner Name: � �C � S HC_ t kJ Phone:
Mailing Address:
Physical Address:
Facility Contact: d Title: © YA -e Phone:
Onsite Representative:
Certified Operator: Michael S c I k.tQm b T �^
Region: F'kQ
Integrator: M-"V
Certification Number: I&7c) 9
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. W,et Poultry Cap ity Pop.
_ Design Current
Cattie Capacity Pop.
Wean to Finish [Layer
Dairy Cow
Wean to Feeder
L
jNon-Layer
I
Dairy Calf
Feeder to Finish
" `"
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Non -Dairy
Farrow to Feeder
D . P,oul Ca act P,o .
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes $2 No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
I n-i No
❑ NA
❑ NE
❑ Yes
F�g No
❑ NA
❑ NE
Page 1 of 3
21412011 Continued

Facili `Number: Date of Inspection: 13
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Ig ` I q
Observed Freeboard (in): Lt 3 - W_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 15�j No ❑ NA ❑ NE
❑ Yes [nNo ❑ 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 M No ❑ NA ❑ NE
8. Do any of the structures 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 El No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Eff No DNA - ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes tK No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1�1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
S' No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
U No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JR No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
LCJ
[VfNA ❑ NE
Page 2 of 3 21412011 Continued

Facifl Number: - 3 Date of Inspec tion:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No [DNA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility'fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ig No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
Ca No
❑ NA
❑ NE
❑ Yes C9 No ❑ NA ❑ NE
❑ Yes [�fNo ❑ NA ❑ NE
❑ Yes F2 No ❑ NA ❑ NE
LIAM
❑ Yes No
[:]Yes ® No
❑ Yes No
-7, VVNe- e. ea, irOh 0-1 Of by am, Vtodoeer wr kyg on row
b ►4� qmak 1g la W/o'
S�(�Comn�, `� r
1
Goad rewds,
Reviewer/Inspector Name: r
Reviewer/inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Phone:
Date: a ao f
/4/101I

Facility No. '�07 -63 -Farm Name S(Oiff HG+&b Dated 0 [ t�
Permit ✓ COC ✓ OIC_ N PDES (Rain breaker PLAT
Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard I Last Recorded (in)
50
Observed freeboard
Sludge Survey Date
Sludge Depth ft
r
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
3�
Date out of compliance/ POA?
►7`h��llL"i:�r1 i�'l:/TiTi�i'Lad!?1�'�%I
Design-Diamw
�lL�li�Actual
Di am.
Soil Test Date
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP ��
Dead box or incinerator
Lime Applied
Weekly Freeboar
Mortality Records
Cu-I L-"' Zn I
1 in Inspections
Check Lists
Needs S (S-1<25) NP
120 min Insp.
Storm Water
Needs P
Weather Cndes
• .
. .
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm ` h � I%p Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac
If.

Type of Visit: 12FCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
c- Arrival Time:
1I ,. Q�� j6'l Departure Time: County:,
Farm Name:S d f ' "b I (-) 0, ob# f -K�.fJ'� � Owner Email:
Owner Name: Mieh l "S000 II }M_&(Mh Phone:
Mailing Address: �ff
Physical Address: 1364 fyy�� erny If �•' kill
Facility Contact: SC04 He -limb Title: Ovyn$^
Onsite Representative: I Integrator:
Certified Operator: b 1 ci1�� r [C.L. b Certification Number: 10) y
Region: 1 ��
Back-up Operator:
Location of Farm:
Latitude:
Phone:
N-19
Certification Number:
Longitude:
Design Current= Design Current _. Design Current
Swim Capacity ''Pop > Wet Poaltry Capacity Pop Cattle Capacity Pop.
::... w
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I
Dairy Calf
jNon-LMer I
Feeder to Finish
4
k
Design
Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dr. P,ouIt . Ga aei ,iE.,
Po
Non-Dauy
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
_
Turkeys
Other _ _ _
Turkey Puults
Other
Other
Discharges and Stream Impacts
. 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 'fD No ❑ NA ❑ NE
❑ Yes
❑ No.
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
C-No
❑ NA
❑ NE
Page l of 3 21412011 Continued

Facility Number: i5a - $ Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fR 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): Sg 5 5(0 55-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[51 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
O No
[:]NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�C] 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
�;j No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes tRrNo ❑ 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): Lvtlm-da Hay 4 VopT ,-e- (1(n . 0eat,S6v to n i `. CAn ` h i JeF
13. Soil Type(s): VrMlk lofty5&YL` b Coo
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
*'Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
ff�"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
_UNo
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
[5�TIo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
0 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 El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
2q NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: a !
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ErNo [DNA ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes ❑ No [RNA ❑ NE
❑ Yes r5j`No ❑ NA ❑ NE
❑ Yes tR No [3 NA [] NE
❑ Yes n No ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. yes ❑ No
El Application Field ❑ Lagoon/Storage Pond [aOther:�m 4-0r(1(ye �d >�[o�1
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3 No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [E No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [A�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
y �'
omments.grefer to question Explain an YES answers and/or an additional recommendations or, an o _ n"n' ts. q . ther co
i seAtawin s of [acuity to better explain situations (use, additronal pages.as necessary): P
15, Plain �h -}o s r � 8 -��h�P� , �i-�. nPGI� � �v� (rim �. ►� ��
or
1Ng� F 101
aS= oan3 sl�Gdye-v volvme
-�i ejc r�'C �" C ran q00 f 4 Os, n aboae.
,_ U
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L03-3333
(offiCe)
Date: a
2/ /20I1

Facility No. $a $� Farm Name S 0W1601j� Date
Permit COC —sL OIC ,�VPDES (Rainbreaker PLAT Annual Cert )
.:
m
RM11
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date 1! a
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
5
5'
Actual
Design Width
Soil Test Date ti Wettable Acres . Ive W RAIN GAUGE
pH Fields WUP ]� I✓ Dead box or incinerator
Lime Needed - jv Weekly Freeboard i,,-f Mortality Records
Lime Applied 1 in Inspections
Cu-1 Zn-1 120 min Insp.
Needs PQ_ Weather Codes
Cann YiPlri Tran-,fPr ShPPfs
Waste -Mn��m�o
m. _mom
:tom
PLA-VIFiekd
•
.•
.•
��if
lak+l� •
OM 1
aa
i
`b M s rflGrc6,=fates r i -
Verify PHONE NUMB RS and affiliations j
Date last WUP FRO 1 %1Q) Date last WUP at farm i �3��D App. Hardware
FRO or Farm Records {{�� p
Lagoon # Y �( s+ m- - + m �y� r
Top Dike C�\�T C[.�)
Stop Pump Lvri7f
Start Pump
Conversion- Cu-I 3000= 108 lblac; Zn-i 3000= 213 Ib/ac

G
I H � 'US
M.
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: a At in I Arrival Time: $ r Departure Time: �0 County: ,0 S Region:
Farm Name: `-' M6L&,-b #) 4 a Owner Email:
Owner Name: _H tchop j S, _ _ Hckam h Phone:
Mailing Address:
Physical Address:
Facility Contact: t ke— Ne'L ig Title: Ovyll �p PhoneNo: 32 5_ F
Onsite Representative: _11 � GM_ _ integrator: H �
Certified Operator: r`c�� s _ �Q b Operator Certification Number: 167.
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e [� i [� N Longitude: 1--] o =' = "
Design 1ur—rent Design Current
Pulton WetPoultary Capacity Poplaton
Design Currentcity
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑
Dai Cow
❑ Wean to Feeder
❑Non -La er
❑
DairyCalf
DaiEy Heifer
Feeder to Finish
Dr}'Poultry
❑
❑
El
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Cow
Non-Dairy
❑ Layers
❑Beef
Farrow to Finish
Stocker
Non -La ers El
Gilts
roo
Boars
El
Beef Feeder
❑Pullets
❑Beef
Brood Cowl
❑ Turkeys
Other
Number of Structures:
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
.. ❑ Yes
❑ No
❑ NA
El NE
❑ Yes
❑ NA
❑ NE
❑ No
❑ Yes
('No
❑ NA
❑ NE
❑ Yes
Jallo
❑ NA
❑ NE
Pine I uf3 12128104 Continued

i Facility Number: $.1 Date of Inspection Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 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): 19 _ 1 q Ifq ^� 12
Observed Freeboard (in): L4o "IS
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15�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
f'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
�kNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
t�cNo
❑ 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
[S'No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
JR No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind/
Drift []Application Outside of
Area
12. Crop type(s) L�
Ci7
,°l�►t Qy -�QJ ram' Coro ,,41' Sm bbeaj �
r
Ce fg�ll
—.
13. Soil types) �� . C�s2Id,r,JDlQ $
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fjj 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
t' 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
&Io
❑ NA ❑ NE
Comm_ ents (refer to�gpestion #�Eaplam amy YESansv►ers and/or any recommendations or anv other comments.
7.Dse drawings of,factlity to better explam sttuahons(ue addthonal pages as necessary)
a
�Jo 308- (ems
Reviewer/Inspector Name 11 �� Phone: 1 q33-0333
Reviewer/Inspector Signature: Date:
,­ ? „f z 12128104 Continued

• Facility Number:$ —$3 Date of Inspection Mwi [
Ree uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'ONo ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soi] 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 19 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ER 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
E'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Callo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[N-NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2rNo
❑ 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
D37No
❑ 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
9-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
[ff'No
[:]'NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C'No
❑ NA
❑ NE
-eHee Ff-Oks kls' Xf l w U'I)e ao r o , Wo fe PtQ,, red oie io 7'vt
a y < New pSvv+j a,d_ need were_ Cali brace t o Se l o, a o r o:
SI Ldje
� Qr� showsr
H$°yo, WII1 honot- Vta,er�sha--y f+hi�cs
o
%y«�n 3 ,
�dC�e, w ill have- y �°cr i �a C� v�� � �uymo�s. q^e (Yt9oct
'0 ar -Far as s("dge_
i5 �ield3 we-� lt�n F'I>7 -� V mas�
a i, ,Soi 1 13 i +o be d �° a�
Co ocd-
9 9
Goocdtecordj p,,k
Page 3 of 3 12128104

• Facility No. �3 Farm Name
Permit ✓COC
Fm E-
-
H "U Date 10 , l i V
OIC_
FB
Drops
NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
X
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
149
IIl.A�.� 33r�
Actual Width
.��Ci��Cy
3�
10
1646" _v1_ Ft_ 1­9/�. 11�
Soil Test Date bl Acres `� RAIN GAUGE
pH Fields , R 4S3 � �- Dead box or incinerator
Lime Needed OO P&- Weekly Freeboard Mortality Records
Lime Applied �� 1 in Inspections S1v�0 a
Cu-I f Zn-I 120 min Insp.
Needs P Weather Codes I
Cron Yield TrgngfPr ghppt- C04&- 60V T ba-t L4
. 1 0
` . 1 / I
� , .. ►'
J
�'�
F,`. � ilia►���Jlfn�
•
1K4 WA M`1&�IFA
Av
rt MIA
NMI
L BOL016 �A.101z' 0 74�
M.
�1s.:
����'�lr�Memo
_
{
141
Verify PHONE NUMBERS and affiliations
Date last WUP FRO` I j $ 1 � Date last
WU P at farrT
FRO or Farm Records �MD
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
6rala( 10yT h*f ^
�AAppp. Hardware

Type of Visit aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit I.S Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: 12 ,�Ilcal
lArrival Time: ' . •its Departure Time: •Qr'�� County: Region: ko
Farm Name: SCcTH Hd,+'F fignb �- - Q015c &G n b 1
r Owner Email:
Owner Name: i c1)�' [ �- He (4 1 Phone:
Mailing Address: j-3 `� ��r�a 7-,ev H 1 V (L f U ).e h_ &n 0337'4
Physical Address:
Facility Contact: rfjt NC Leg!! h Title: 0'1='i''l .1 Phone No: �
Onsite Representative: Integrator: IVI Phi- &oi ,g
II Y
Certified Operator: � C ha*' l 3 MC �' Operator Certification Number: A10 167) y
Back-up Operator -
Back -up Certification Number:
Location of Farm: Latitude: = e = I = µ Longitude: ❑ e = 4 = 6i
Design. Current Design
CapUiKkty Population Wet Poultry Capacity
❑ Wean to Finish ❑ Layer
Cnrrent
Population
Cattle
❑ Dairy Cow
Design Current
Capacity Population
❑ Wean to Feeder
I
Non -Layer
❑ Dairy Calf
Feeder to Finish
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
"❑ Non -Layers
El Pullets
❑ Turkeys
- ❑ Turkey Poults
❑ Other
❑ Gilts
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Boars
m
Other �, x-�'�
❑ Other
Discharges & Stream Impacts
i- is any discharge observed from any part of the operation?
❑ Yes
J'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
�d No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5kNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

t
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ 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): rq
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes a 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 tRNo ❑ 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? H Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J�tNo
❑ 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
C&No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
)a No
❑ NA ❑ NE
maintenance/improvement'?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
15 'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)P'A^ V cl0- W1.1 IGj1 C(lfr^, L �(r!r► 'l� �r
,
13. Soil type(s) ,ltl elk
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
`2No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA ❑ NE
10. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
5ir No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA ❑ NE
;.Comments (refer to gneshon:'#) Explain any YES answers and/or any "recommendations or any othercomments .
Use Tawtngs'of facilih to better explainsitual ons (use additional pages as necessary):
x
f
1W
Reviewer/Inspector Name Phon�r'
Reviewer/Inspector Signature: -.> Date:
12 8/04 Continued

M
Facility Number:—''{� Date of Inspection )T
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp [] Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 1;� No
❑ Yes q No
❑NA [I NE
El NA ❑NE
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes RNo
❑ Yes ❑ No
❑ Yes Q No
❑ Yes ffNo
❑ Yes 1' No
❑ Yes ER No
El NA El NE
(R�NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑NA El NE
❑ Yes
"� No
❑ NA
❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
t f, i Ci 'w Ld e bre s f t�� I Ct�C r q b_t jr, C � 0-C L�� �Xi+ �'rl?,} [ C� L/ .
u �J ,J J
c e co d rf�[y � ScrvP Ht�f' 6,1dlr�ra f
f�cac�� 4 ver
S� n� th b Sw'�,Pf S�a� C�I�r{-o r1, Co �1�� %2�S �f'3 lPc� o-t �)e't��.I hie
o,l0)a(Is b OP Z
�11� arma a� ibslre- bA- w$e Or- .a It PC- �d fn. T � poor vcer rAg, ipot+v, of flake
aJ l uer i-nPd ifi r' 1 �� �; Ali 00107 b � � q faplo ,r ��,�1
9 r p �. �
-gyp chun9 e `(6A� b 4 4e sad ,� fire -fie �l e as der f�► �'t 1 e I off` /Pl�� ,
�
12128104

+ 6
Facility No. —�� j Farm Name +C �dt'n� Date
Permit COC ✓ OIC____
NPDES (Rainbreaker PLAT Annual Cert )
Pop.Type Design Current FB Drops 3• .,
Lagoon J
1`
2
3
4
5
6
7
S iilwa
Design freeboard
Observed freeboard_(in)
Sludge Survey Date
L
Sludge Depth ft & %
Liquid Trt. Zone ft
Design
Soil Test Date,, r
Wettable Acres
Weather Codes ✓
pH Fields
WUP -n/
Transfer Sheets
Lime Needed—
Weekly Freeboard /
RAIN GAUGE
Lime Applied
�j--rr
Rainfall >1" v1
Dead box or incinerator
Cu
ZnnS`�'�`
1 in Inspections �,�
Mortality Records
Needs P
120 min Inspections
Croo Yield
-Waste Analysis Date
lip
/G
]. 7 -i, -4 -, 1 ral -vLh(, tf 't-r'1')
Pull/Field
Soil
-Crop
RYE
PAN
Window
Max Rate
Max Amt
r
•r
I1
�ii'1 ._�jr
�
r llev�k���
vnALI-
�5�570
r
�
(Ji e tt (G-
Verify PHONE NUMBE, S and affiliations
Date last WUP FROj13(V fe 30(.cC, Date last WUP at farm
r
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Approx. Conversion- Cu-I 3000= 108 iblac; Zn-I 3000= 213 Iblac
Plve
App. Hardware
n
t) �c•�ML!

r
1�
li
n
i

Type of Visit UCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit OkRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t�� Arrival Time: Q ;n� Departure Time: 10�, County: Sawl Region: AO
Farm Name: SCO-j" Me� &b�#-I.4-#a— o„ me „b _ Owner Email:
Owner Name: WrhnelS i-ICUbb _ Phone:
Mailing Address: H1 u L- PQw 6 pop
Physical Address: ��jj
Facility Contact: ScA �t.cL&nb Title: Q►vMe­ Phone No: vs—(n,.11 (c
Onsite Representative: Scut- Mc amA - Integrator:
Certified Operator: BL-had '51. r-IGt.-alnh _ Operator Certification Number: YA 167a i
i Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 ='
= Longitude: = ° = d = it
Design r�rent���r- . ~Design
Current -� Design Current
Swine
Gapac�ty, 1Populatton Wet Poultry
Capacity Populaton'aCa,ttle Capaci ty Population
n to Finish
[] La ern
to Feeder]
Non -La erer
to Finish
't ':
r .
w to Weanry
Poultry
t
to Feeder�ww
FElFarrow
to Finish
La ers
❑Non -La erss
❑PulletsTurke
s =' ' ❑ Turke Poults
❑Other
Number of Structures:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Doi
❑ Beef Stacker
❑ Beef Feeder
❑ Beef Brood Co
Disc^ harzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
tNo
❑ 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 past discharge from any part of the operation?
❑ Yes
EUNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

' Facility Number!tj -IM3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IgNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I' Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19 I4 4
Observed Freeboard (in): 5 40 (41
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes C.No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes UdNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CBNo ❑ 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 ;9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes RNo [I NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (�j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) COA-61 B$'M d0 j � j Pj , Corn ., 301he6s. ` �11' J,I-ej S& as
13.
Soil type(s) lVt)_ I S `, &oA 11
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
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
RNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
5a No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
UkVo
❑ NA
❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 0671W8
Page 2 of 3 12128104 Continued

l
Facility Number: 13a Date of Inspection
R uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �R No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 12 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 12 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No IRNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 15 No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes W No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes N No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
$5 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Addit>oual�Commeuts � andloDrawtngs, ,1 1.
le
p �� -F�J inn �Px1F ro.�.��in�
al. oe_ h&e Cori& sgMrt ire S or
�,-f yD n w;R/ shows n
VP ffd -ay lm oaf - b-t
1/l�l �r
" ;l,.gam
ysvC Ie arvf,lI h2 r�dae
�
T.
Plo�fihy rye-h� 1 r week.
7. Gook CXvif or1 I alioms,44 ro - f xeA sNte I #if yeW.
Cnll aft-farcJal_6tq$0,/n04rOl-pal CaJ]
Page 3 of 3 12128104

Facility No.. i5a`W Farm Name 5COff rfG104 b' Date
Permit / COC ✓ OICNPDES (Rainbreaker
FIB Drops
PLAT Annual Cert )
Lagoon
1
2
3
4
5•
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date Perm Liquid ft
C
.$
31
4.
1 0 Sludge De th ft
OAS
q
Design Flow
��
----
Design Wi.
RITESMIN ff ME
:_i'�------
Soil Test Date ✓ 1 in'lnspections
pH Fields Crop Yield 120 min Inspections ✓
Lime Needed Alf5a�f Wettable Acres Weather Codes .✓
Lime Applied �qe,� WUP Transfer Sheets
Cu No % Zn ✓ ' �`Weekly Freeboard RAIN GAUGE
Needs P Rainfall >1" ✓
Waste Analysl s-- '
EllIN."07=51
r ,
�i ►j'
fig
Gal) —WE.
f
Date of last WUP FRO Date of last WUP at farm Ann- Hardware Max Rate Max Amt I
Pull/Field
Soil
Crop
RYE
PAN
Window
3�
S
_e
mill —(W'
16 14
aPb
ill
3c V
Verify phone numbers and affiliations
QUW
Chit [�*' 19" 40 �
&6-ee a 41
01) 16nn
bift
ftdr w

}� h
lh'C��s
W4 ma 's

r ' Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation O�
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (& Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % �OlZn ArrivalTime: U 10 Departure Time: County':
Farm Name: S I i t�l b I _ LWA MI -la" Owner Email:
Owner Name: ,._S _Ol � � QL Vy .to _ Phone:
Mailing Address:
Physical Address:
n Region:
Facility Contact: C Title: Phone No:
C
Onsite Representative: C O_ ` Integrator:
Certified Operator: SCIA-C Z Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
O
3 O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =o E=]' =" Longitude: 00 0I = K
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Non-L,
Pullets
IL-1 Turkev PoultsI 1 1.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
@urren
Cattle
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
r,
Number of Structures:
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
■
❑ Yes [� No El NA El NE
❑ Yes
❑ No V NA
❑ NE
❑ Yes
❑ No J NA
❑ NE
❑ Yes
❑ No ANA
❑ NE
❑ Yes
E jNo ❑ NA
❑ NE
❑ Yes
❑ No _jj�NA
❑ NE
12128104 Continued

Facility Numller: ;E S Date of Inspection 11 0
t•
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA El NE
a. If yes, is waste level into the structural freeboard? El Yes No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Struc e 4 Structure 5 Structure 6
Identifier: Z—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes QtNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[--]Yes RNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes allo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes k[14o
❑ 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 PQ)Vo
❑ 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?
]I. Is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes VhNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ fleavy 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 ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) &.I ^, H Y G f e Corn GY"+� . &,,, , M, I l ± G, ,
Gvf a
13. Soil type(s)
O
14. Do the receiving crops dater from those designated in the CAWMP?
❑ Yes
R) No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
13 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
—tEbNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (else additional pages as necessary):
Reviewer/inspector Name UAIQ S? NE OWAM;7Phone: D 33320
Reviewer/Inspector Signature: Date: djoy 3o_a01
12/28/04 Continued

r
Facility Number: Date of Inspection l v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IgNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 9q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
),No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[RNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
04 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[I Yes
N No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R] No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
K[NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CR)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
PqNo
❑ 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
NNo
❑ 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
]PNo
15
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�Q5 "to 14 6-us'-_ a^-d— mrn0'-t4 514 L n
3.
12128104

Facility No. Time In
U Time Out Date i 3c} ��
Farm Name Sea- V'!1C 1 2 r� m� —� Integrator Pry., sl d 4M
Owner C� S c,pTT m� Site Rep
Operator S ( �0t lc _••, No.
Back-up No. -
COC ✓ Circle: General >r NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — � ish
Farrow — Finish
— Finis
C)q
Gilts I Boars
Farrow — Wean
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rain Gauge V✓
Soil Test Wettable Acres
Weekly Freeboard ✓ Daily Rainfall ✓'
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitro 2
en (N)
l� z, z . .S � Z •3
4 z I.a 2Z'D t.
3 7 i,� z. �.S�r•
Observed (PI/ 9-q 7 sbp
-
Calibration/GPM 1 Z_
Waste Transfers
Rain Breaker
PLAT —�
1-in Inspections
Date Nitrogen (N)
Pull/Field
Soil
Crop
Pan
Window
C.0 r r. C-„,,z
I x4
t"^a Y — -T, I
C-
U 3
C

in
]Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
IReason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: Z 10 Arrival Time: Z Departure jTime: I County: Region:
Farm Name:Qc2�r'i i' 1 C(A4Owner Email: l
Owner Name: SC-01ft 1 !y � I al 10 Phoe 9 1D V lD as km
Mailing Address:
Physical Address:
C
Facility Contact: S c Title: Phone No:
Onsite Representative: C_ Integrator: 1�
rri
Certified Operator: t`gym-�__ .._— Operator Certification Number: a'
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' E--] u Longitude: = ° = S = «
0
rDestn Current
Design Current
Design Current
Swine
t�ty Population
Wet Poultry
Capacity Popla"lion
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
El Wean to Feeder
❑Non -La er
❑ DairyCalf
eeder to Finish
Farrow to Wean
x
�_#�
❑ Dai Heifer
El Dry Cow
Dry Poultry
ElLa ers
ElNon-La ers
❑ Pullets
El Turkeys
;''�x
s r°�-...
❑ ry
ElBeef Stocker
❑Beef Feeder
❑ Beef Brood Co
Other
TurkeyPoults
❑ Other
❑ Other
re
Number of Structus:
❑
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
I. Is any discharge observed from any part of the operation?
[I Yes
XNo
ElNA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
ElNo
kNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
�—
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
El Yes
❑ No
NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
�!a
//❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
hNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

i
F
FFa_ci1iTNu`mber.Ta— U Date of Inspection ffull
�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [VSNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No (jlA ❑ NE
Structure 1 Stru� e 2 Structure 3 Sq
cture 4 Structure 5 Structure 6
Identifier: l
Spillway?: II
Designed Freeboard (in): tq
Observed Freeboard (in):
� A
+ 5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes No El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes NDNo ❑ 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 +4 No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes F%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 �RNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 4No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes Wo [:DNA
❑ 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 Window El Evidence of Wirn�d� Drift Application Outside of Area
`Crop
yam❑
12. Crop type(s) � 1'71LJ a t , � Q r �.1 S 111. 14 1-
(it n ll lJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes J�P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes SQ.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes %No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES a savers and/or any recommendations or apy other, comments
Use drawings of facility to better explain situ ahonk {use additional pages as necessary}�;
Bare.
Spo-s on
(a-Smr�
e p- .nIrnP,g4S
need -4
6f- S-4& 4cd
54P
PJ-05F`oI
op 50r,
Irc sr'd 1 mulch
CIS fue id
V. 4r� ,
Reviewer/Inspector Name S 1J1:.: N N Phone: 3 (7
Reviewer/Inspector Signature: [�.�� Date: ec
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection MICI
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V_A.%rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes A No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
r
❑ 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
X No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes.
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ 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
51No
❑ 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
VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
eNo
❑ NA
❑ NE
Additional Comments and/o:r3 Drawings:
Ce (ien COX m
Page 3 of 3 12128104

X�
jo,<
M
Time Out Date
Facility No. �� Time In I� !
Faun Name DR` tt L "L 6A Mc6m� Integrator
Owner Rdmx A A , �Yl Cs� k b Site Rep
Operator - �Cso G rl C- L9� �� No.
Back-up
COC
Circle: General or
_ No. _
DES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
We - ' ' h
Farrow - Finish
reed - Finis
tj �j
Gilts / Boars
can
Others
FREEBOARD: Design
Sludge Survey V/
Crop Yield
Rain Gauge
Soil Test jz
Observed
Calibration/GPM
Waste Transfers
Rain Breaker 3�
PLAT ✓/ Wettable Acres
Weekly Freeboard i% Daily Rainfall ✓
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
i'D hobs S /. q M 1
V
y � Z
1-in Inspections
Date Nitrogen (N)
Z-13 7/ z•r47.Jf.1
Pull/Field
Soil
Crop
Pan
Window
f
Kk &
l f!
sr,-, exy ors
S
I t3
I ds 4ovc:
P
cq `(3.7;
3 h - c7
Z
5,r-,-,Ca. o I S
ANov
a ( L
3aS
33
ti
fn :ltz} GNMz
'Do
5rn q r 0 S
!
CID
IN
Coo R-tlf
! S
i • -- --r 3 l
5m
No f
610
rn r 04
qo 1, 7�
t 3
Gil
dRAJ
16 a
r-

• • .
/A/ S/1- I- a y efy-_�
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q;O Departure Time: County: 4 - 50­, _ Region: r4126
Farm Name: 1��ne^a ,b tl-� y Ad G6t.lrlS Owner Email:
Owner Name: T J a_e> fr /yl a /��_s�,r- Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 }�� Title:
Onsite Representative: rSe l IVt e %.s.�y
Certified Operator: M Z Gi.. �,e/( s . 1�
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 i 0 Longitude: = o= g 0
ds
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Nean to Feeder
Feeder to Finish
5,5
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: �}
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El Yes
r❑,,tJNo
53�� o
❑ NA
❑ NE
El Yes
2'No
❑ NA
❑ NE
12128104 Continued

. ,
Facility Number: — Date of Inspection 3�dS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structu 1 t tructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: / a 3
Spillway?:
Designed Freeboard (in): t
Observed Freeboard (in). — Z U —J e7?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9' o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Q Ro ❑ 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 511% []NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [1Y10 ❑ 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 [U4o ❑ NA ❑ NE
maintenance or improvement?
_Waste Application ,�,/
10. Are there any required buffers. setbacks, or compliance alternatives that need El Yes [9 o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2`N0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) y�
❑ PAN ❑ PAN > 10% or 10 Ibs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil Pe W14 h/le#_
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area VfW
I2. Crop type(s) eL—k & 1,g.1 Oct 4 �r�� va�p� ]' 1:5-.-_� L[ �! vat r�
13. Soil type(s) ewe 6L h 0014
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EKNo. ❑ 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 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes , U,1 ElNA [INE
18. Is there a lack of properly operating waste application equipment? ElYes L3d'No ❑ NA ❑ NE
Reviewer/Inspector Name II ` Phone: 9/Q ! �, f��a✓
Reviewerllaspector Signature: Date: 9 -a 3 - p,S--
12128104 Continued

. ,
Facility Number: � — 3 Date of inspection
Required Records & Documents !!
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes U o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW W readily available? If yes, check ❑ Yes U-4 ❑ NA ❑ NE
the appropirate box. ❑ WCp ❑ Checklists ❑ Design El Maps El Other ,�,
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes &� o ❑ NA ❑ NE
❑ WastelApplitatiett ❑ Wer —r trboznrd ❑ Waste.4—nely— ❑ Gi' ; is ❑ Waste Trans e ❑ ' n
❑ l�i�SrFait ❑ Sleeking ❑ 1244 -Minute ispcctia?is ❑ ns ❑ de
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
2"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EKo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EXo
❑ NA
❑ NE
26.
Did the facility'fail to have an actively certified operator in charge?
❑ Yes
Rio
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
g/o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
[ o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EV-4o
❑ 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
jjKo
❑ 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
[3-1�o
❑ 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
EVNo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
U<o
❑ NA
❑ NE
p►dd+tonal Comurtents,a d%or Drawings: y
SLtti. Z Sc" 3 Srk 9
r. + r y
r. •r
12128104

IType of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: — 7 Time: •• 3a
Facility lumber
!dot O erationaf 0 Below Threshold
40 Permitted EX Certified 0 Conditionally- Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name. +1C Count•: / 51 a Ats 06& r C-
Rb
Owner Name: S Lo-f-�- m G L a N 6 Phone No: `91 a� Sta y — 6-'t -P 2
Mailing Address:
FaCilit\• Contact: Title: Phone No: p
Onsite Representative: Set Sri �' La "�Integrator:
Certified Operator: i " CLae k 5 • e h are- Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �4 Longitude C '
Design Current
Swine C anariti• Ponnlation
❑ Wean to Feeder
® Feeder to Finish
1 g 0NN
7 o&
❑ Farrow to Wean
❑ Farrow- to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acitV Po ulation Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Laver I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons L��---`'--IJ` ❑ Subsurface Drains Present
Holding Ponds / Solid Traps I J❑ No Liquid Waste Managen
Discharges & Stream Impacts
1 _ is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discnarp is obser ed, was the conveyance man-made?
b. If discharge is obsen-ed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from anv part of the operation?
Area ILJ 5prav Field Area
❑ Yes �] No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste!Collection 8 TTCatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier-. 1 ..? 3 y
Freeboard (inches): _ 409 ,► y 4? ►t !� g -- H8
❑ Yes ❑ No
Nla
❑ Yes ❑ No
❑ Yes No
❑ Yes (!�No
❑ Yes M No
Structure 5
05103101 Continued

Facility Number: g.� — P Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, E] Yes S No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 1P No
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 maintenancefunprovement? [;9 Yes ® No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste A01P icatiOn
10. Are there any buffers that need mainteuancefimprovement? ❑ Yes ® No
11. is there evidence of over application? If yes, check the appropriate box below. ❑ yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
n r �j /
f a ff r ' a nx�1. I2. Crop type �e v w�.s4��T_c;y��rdG. rrt Cs s ,.� 3 . �.SCrsGr GJ „c.r;c r I�ri n val . Sk J7� M[Gr
13. Do the receiving crops differ with thoseTdesignated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [$ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes j No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes 1P No
lb. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation? r
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1;9 No
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 [$ No
Air Quality representative immediately.
Final Notes
7. E'1a,�t�,�u a +o
Work. o},
la yoa., 6-
,ks. t3a
c
spd+j q�
otic xPo-t-
o-/�roSao w
o b., +1,-c
ces,,Gr. mr'.
r11` L4wh
t 5 P�ar,'�i.y
4 va�s4s,
/"es C" C X 0 GI aQ tl V 6 t c. "1 '7 "'X- Q,., 4c Gam'! 13 l' b c- S c C dCIC,
Need o Ks C. *6( -Ca c.r.U � a a 1 ea G.S. T 4 c ti ago s C c.+ ; 11 b
C r 14. ti b 5 C �aQk r_ok 'N,. 6, V er t & C'CcQ.
Reviewer/Inspector Name
ReviewerAnspectar Signature:
Dab-: 0-- -0 7-- d %
12112/!!3 // Cowed

Facility Number: ff .2 _ f3 I Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [A No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wi3P, checklists, design, maps, etc.) ❑ Yes [g No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
IF
❑ 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? ❑ Yes [f No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [� No
27. Did Reviewerfimpector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes EgNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ] Yes ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes U No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ® No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ® No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes PO No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: Mo
Facility No. I - so
DIVISION OF ENVIRONMENTAL MANAGEMENT . _
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: t let, 1995
Time: Z : CIO. P. #I
Farm NamelOwner. a [ f6 c_ Farms P. t Me -
Mailing Address: ! G m` ip bo r z 3 L
County: Swovs a• _
Integrator: rA r' Phone'
On Site Representative. M Phone:
Physical Address/Location: aEE tjTM �•
of-�- ° Sb o-
Type of Operation: Swine 2s- Poultry Cattle
Design Capacity: f3l2qj -Feet Number of Animals on Site: EoYq ft%m Lv
DEM Certification Number: ACE DEM Certification Number: AC
Latitude: ' Longitude: •
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �&or No Actual Freeboard:.Ft. Moriches
Was any seepage observed from the Ia n(s). Yes or® Was any erosion ob rved? Yes o T
Is adequate land available for spray? Y or No Is the cover crop adequate? or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin . Y or No
100 Feet from Wells? e o
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue e: Yes or�
Is animal waste discharged into water of state by man-made ditch, flushing system, or other
similar man-made devices? Yes orIf Yes, Please Explain.
Does the facility maintain adequate waste management reco (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: Fiwm F*s rrAt'sizrd . $"r" orra-
EJ _Su
Inspector Name
Signature
_ _ ti sike Free
4 utrt 11
cc: Facility Assessment Unit
Use Attachments if Needed.

State of North Carolina
Department of Environment,
p Health and Natural Resources ~° . •
Fayetteville Regional Office
James B. Hunt, Jr'., Governor AM
� �
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 13, 1995
Mr. McLamb
Double Mac Farms
1364 Penny Tew Mill Road
Roseboro, NC 28382
Dear Mr. McLamb:
I would like to extend my sincere thanks for allowing me to visit your farm on
November 8, 1995. The facilities appeared to be in good condition and properly managed.
However, I noticed you were expanding your operation and I feel that you should be made
aware of the new regulations that regard to new or expanded facilities. I have included a
collection of new buffer zones that apply to any new'or expanded facilities. In addition,
please understand that no animals can be stocked in new houses without first obtaining a
certified waste management plan.
If you have any questions regarding the new regulations, please feel free to contact
me at [phone] or your local extension agent.
Sincerely.
Ed Buchan
Environmental Engineer I
WachmAa Building, Suite 714, FayetteWe, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportuiity Affirmative Action Employer 50% recydecil IOX post -consumer paper

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site Requires Immediate A bon: N 0
Facility No.
DMSION OF ENVIRONIviENTAL MANAGEMENT
.ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 6v , 1995
Time: 1�3
Farm Name/Owner: -G X`c 1IZ-4,y Y
Mailing Address' f - C - Z'
County: C
Integrator: Phone:
On Site Representative: S. CLLMrn'- Ip Phone:
Physical Address/Location: �_��j w-e
rt
Type of Operation: Swine Poultry Cattle
Design Capacity: ^�7,,Z- Number of Animals on Site: _ ZZ.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) r No Aqual Freeboard: —Ft. _)_Inches
Was any seepage observed from the n(s)? Yes or 4 Dovas any erosion o6 ed? Yes or(o
Is adequate land available for sprays or No Is the cover crop adequate? (e or No
Crop(s) being utilized: Go�S�cU
f ——
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin&04A or No
100 Feet from Wells? a Or —No
Is the animal waste stockpiled within I00 Feet of USGS Blue Line Stream? Yes or eo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or N�o
Is animal waste discharged into water o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes of NJ If Yes, Please Explain.
Does the facility maintain adequate waste management records (vol mes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or ` � l
Additional Comments: ��~ Y+►b � ks tA� tom__ Vo _ 0A na .n„N-,,.
Inspector Name Sig
cc: Facility Assessment Unit Use Attachments if Needed.