820090_INSPECTIONS_20171231

�Vn
NORTH CAROLINA .�
Department of Environmental Qual

Type of Visit: 0 Compli oce Inspection Q Operation Review Q Structure Evaluation C) Technical Assistance
Reason for Visit: 019outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: O County: Region:
IV
FarmName: �fi� f 'p / r✓t� Z,; Owner Email: ``--
Owner Name: i.0 �r� iTD F:-a Fw- ^��y G , Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:1.
Certified Operator:Certification Number:
Back-up Operator:Certification Number: ,ram LJ g`
Location of Farm:
Latitude:
Longitude:
J.
��� � �Destgn, CnrrentMDegn
Current `°� x Design
Curnt
wine Capac�tyl Pop.
�
WetpaciRy Pop. Cattle t Capacity
r
Pop.
Wean to Finish
La er
DanyCow
Wean to Feeder
-Layer er
Dairy Calf
eeder to Finish
pry
Dairy Heifer
Farrow to Wean
Desrgi5
Current Dry Cow
Farrow to Feeder
D , .,Foul Ca ac' ,.,
Layers
Po ° „ � . Non -Dairy
Farrow to Finish
�., Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
Turkey Poults
Other
dam_
�=_ � •-�
Other
..�a,�.;-...s:�..�.,.. .
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 DW R)
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 ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No
❑ Yes LJ No
❑ Yes []"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
!loon 1 '.f 2 7id/7n 1 s

• FaciHty Number: - 7 jDate of Inspection -
Waste Collection & Treatment
`. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 N ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes l3 1VO ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ea -go ❑ 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 [j] N ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [f]-No ❑ NA ❑ NE
maintenance or improvement?
i I _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D N ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop j
Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ;j�r'.�rra la /,Jk- f'e'- r �/ JAI.- .v�r✓ /Tl7vl. / . St"s��s-, r�171i=r
13. Soil TYpe(s): P22'- i-- 411 /f-r-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3'-No
❑ 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
E] N' o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
En"No
❑ NA
❑ N I-
Reuuired 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
[a_ -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
[D No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[]No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
]�No
[] NA
❑ NE
Page 2 of 3 21412015 Continued

• Faciti Number: " oZ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EnNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FErNo ❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0No ❑ 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)
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
nnciinn.�il=iiiriilgin-onive:�i�`Clanrvraeconrl /nronvto
®No ❑NA ❑NE
0 No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
73
fU% � sl ✓>'� �%�x� �" yL �J �.�� /%rim � �� f .� :���� r n T h � G---��,{�•�`—�
Reviewer/Inspector Name:
Phone: 2D-'-D <—01- /
Reviewer/Inspector Signature:
Page 3 of
Date:
2/4/201 S

Type of Visit: ffCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 EmerQencv 0 Other 0 Denied Access 11
Date of Visit: Arrival Time: 1 1,9,'-30 1 Departure Time: r'3 c7 County: Region: �r[�
dol
Farm Name: ,/'�' �g� ,r-�-r— l�d.�n�s �-�-i7G. . _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1-ruJ Title: ©(lJyt Phone:
Onsite Representative: ' S'� _ Integrator:
Certified Operator: Urn' ; Fr - Certification Number:
Back-up Operator: ��. Kj � Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
/
Design Current Design Current
Wet Ponitry Capacity Pop. Cattle Capacity Pop.
Layer Daig Cow
Wean to Feeder
jNon-Layer
I
Daig Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
e Dry Cow
E! , W P■nuI Ca aci Pao Non-Daizy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
_
Other
Other
Turke Poults
Other
Dischar es 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?
❑ Yes E&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 No
[:]Yes [3-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

[Facility Number: - Date of Inspection:
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): 33 3 -a
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
®.No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
[—]Yes ZNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[RNo
❑ NA
0 NE
waste management or closure plan?
If any of questions 476 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
O�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
[?JNo
❑ 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 MNo 0 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 A❑ Application Outside of Approved Area
12. Crop TYPe(s)= rnadtd f�S�r� l�r�-+'! r✓` J� ��S'lowl17t-.��
13. Soil Type(s):1 /r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ONE
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 allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes 0 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 0 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 EC No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E5�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

" Facifi Number: - O Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �RNo 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Jallo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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)
3 I . Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fait to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EjNo ❑ NA ❑ NE
❑ Yes E3,No ❑ NA ❑ NE
❑ Yes P3,No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes allo
❑ Yes [&No
❑ Yes ff�No
uJiw
ReviewerAnspector Name:
Reviewer/inspector Signatuw
❑NA []NE
❑NA ❑NE
❑ NA ❑ NE
Phone: ZZ-V �.3d.3�a/_5__/
Date: �7/ ?
21412015
Page 3 of 3

typc w visit: t_J 1.ompuance inspection v vperation xeview lJ structure Evaluation V lecnnicai Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: %r County: Region: [�0
Farm Name: Q��lL-/` FGtr�"'i ^� `n6, Owner Email:
Owner Name: /,� ti ar'�Yr- S �L t t C . Phone:
vv -
Mailing Address:
Physical Address:
Facility Contact:
7U�2 e-al_..t
Title: Phone:
Onsite Representative: R
S
integrator: 4�3
Certified Operator:
�` �
Certification Number:
to rro 9-5—
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Wean to Feeder
Current
Pop.
Wet Poultry
(Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Da' Calf
Feeder to Finish
- �—
D . Purl
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
10ther
Design
Ca aci
Current
P,o ,
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
D_ ischarges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C2fNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
EE No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faciii Number: 5 Date of Ins ection:
Waste Collection & Treatment
'= 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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
&No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public
health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Qt 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
[Z-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E .No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)=-�r+ur��a
13. Soil Type(s): �rG�Vlll�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 12 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
[2 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
[ONo
❑ 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 Omer:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekiy 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 [g No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rM No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZLNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E3No 0 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 ®, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J.No ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes C!fNo ❑ NA ❑ NE
❑ Yes E�JNo
❑ Yes [RNo
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: /o—���
21412015

r.
Type of Visit: QrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 046utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I5�rr�ANT Arrival Time: Departure Time: County Region: f?j-z, o
Farm Name: f �korter- T) FQ fmr r� Owner Email:
�v
Owner Name: & 11Af-�7-r �j) FcfnM3 nG, Phone:
Mailing Address:
Physical Address:
Facility Contact: Ly��ldr� Title: QG,:�//7Phone:
Onsite Representative: Integrator: /'
.01
Certified Operator: Certification Number: 16 d xJ—
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
Layer
I
airy Cow
Wean to Feeder
I
INon-Layer
I
airy Calf
Dairy Heifer
eeder to Finish 3 If 0 3 jt,
Design Current_
D . P.oultr Ca aci Po P.
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
r7BBeef Brood Cow
1 1. � 01�_
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste 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 CE�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[Z No
. ❑ NA
❑ NE
❑ Yes
fo No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Number: - i) Date of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®--No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
n 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
0 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
N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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
g!-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[21.No
❑ NA
❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & _Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
® No
❑ NA
0 NE
❑ Yes
E-No
NA
❑ NE
❑ Yes
S No
❑ NA
❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1 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 ENo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214/1011 Continued

Facili Number: - W 7 Date of inspection: �S-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to
No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ NA ❑ NE
❑ NA NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CK No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes CK No ❑ NA ❑ NE
❑ Yes
®. No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
Phone:/D y
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Date of Visit: 91 1 Arrival Time: ; oc7 Departure Time: //�j� County; D_ — Region: '
Farm Name: a rrn.s _7jy C , Owner Email:
Owner Name: �yl Q rfi�r�Gt/r1L.s ��?G, Phone:
Mailing Address:
Physical Address:
Facility Contact: 12.__ Title: Own t'✓ Phone:
Onsite Representative: Integrator: ✓z:�s
.01
Certified Operator: x� Certification Number: /la 6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Currents Des, n Current
Design Current
Swine Ca aci Po Wet Poult Ca aci lop,Cattle
P tJ' P ry` t3'•
2. " -a aci Po
P ty P•
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
IDry Cow
Farrow to Feeder
I] . Poul Ca .achy l;o ,
Layers
Non -Dairy
Farrow to Finish
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?
❑ Yes [2j No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
a No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[2 No
❑ NA
ONE
of the State other than from a discharge?
Page l of 3 21412011 Continued

FaciliNumber: Date of Inspection:
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): 19 l
Observed Freeboard (in): '31c) ,3`S-')
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�- No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes 5� No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
21 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
S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[5 , No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2[ No
❑ NA
❑ NE
maintenance or improvement?
Waste ARRlication
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 WNo ❑ 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): $`� / /d-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes EA No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes LD No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes allo ❑ NA ❑ NE
[:]Yes VLNo ❑ 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 R No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 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 Dn No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: fS'
l• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo ❑ 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 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o No DNA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes [N�No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes 5g, No
❑ Yes ® No
[:]Yes Z�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name
Phone: P?2p o
Reviewer/Inspector Signature: Date:
— z
Page 3 of 3 21412011

0. b 1 % Dn .3 4-7113
Type of Visit: 10 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: G) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ESQ Departure Time: R County: �Q1 Region:
Farm Name:
Owner Name: &V&-kt
Mailing Address:
Owner Email:
Phone:
Physical Address: tigeQ &/, MCCA4101 IV- Falso7
Facility Contact: LiQ Title: ©�' Phone:
Onsite Representative: Lew botdfj Integrator: Qt,e6a
1
Certified Operator: Lew DQrd. h Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
g � ent
�
Design Current
TCapPo
ty p
.Wet�Poul try
_Current
p ity PoF.
Ca act
Cattle Capacity PoF.
Wean to Finish
airy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish Qr
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . Potil
C{ apaci Pao
Non -Da -
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Turkeys
Other
Turkex Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CR No [] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 5j'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

!Facility Number: - Q Date of Ins ection: 3 126
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
C] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): a-] — --� 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
" No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
R 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
FC] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
10 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
a 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 [RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C #JhA u 1
13. Soil Type(s): Vr
14. Do the receiving crops differ from those designated in the CA W MP? 0 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
[R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'�R No
❑ NA
❑ NE
Required Records &_Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes
a No
❑ NA
❑ NE
23. 1 f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
W NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: S IDate of Inspection: ,3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
rk3 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
allo
UNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
[—]No
[R NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
&� No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Pg 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
eg 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
CR No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CgNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
av5
7. Air va1vj wRe lateJ. sPnc_ 10 ear el��iror� V F��-el a� ��s p y 1 �
De cat 1,1 a4l caVe>
�9
( S)
P5, Pto b4b I e lei' ble �n Sl udje_ eXemeWo� i f Co fir � slVdjf s.//►Qf s s 07++o7
Wdl mai AAed -mod_ o&L refolds',
�- L-f-om b�� :rG
p
Reviewed]nspector Name: _JAon Sc h we i er _ Phone: q i3333 [AreJ
Reviewer/Inspector Signature: Date: H aA aQ. a 0 13
Page 3 of 3 21412011

Facility No: Farm Name Date 13
Permit ✓ COC � ✓ OIC NPDES (Rainbreaker PLAT
Annual Cert Daily Pipe)
Lagoon Name; S fors illwa�-
3
4
5
6
7
Design Freeboard./ Last Recorded in
Observed freeboard;-' '
Sludge SurveDate:
Sludge De tft ft
,tri
Liquid Trt. Zone ft.
Ratio Sludge to Treatment:VoWme ifs 0.45
Date out of compliance/ POA?
IMr MIM�L7I/lTi •:Ti:r Til l
Calibration Date
Ring Sizelin)'_
Design r _
Actual'--�---
r .
• y------
Soil Test Date `{i
Crop Yield
6tai
Transfer Sheets
pH Fields
Wettable Acres
✓'
RAIN GAUGE
Lime Needed
WUP
✓
Dead box or incinerator
Lime Applied';
Weekly Freeboard ✓
Mortality Records
Cu-I Zn-I ✓
1 in Inspections
T
Check Lists
_LL
Needs S (S-k25)
120 min Insp.
Storm Water
NPPriR P I
A j
Weather CndPs
Verify PHONE. NUMBE RS'and'affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm: !� #(p Lagoon #,
App. Hardwar..e i !' ' i Top Dike
I I s
Stop Pump `
Start Pump
i
Conversion- Cu-I 3000=;108,.lb/ac; Zn-I 3000= 213 Ib/ac
wt

6 +ms
03t1)
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 0 Denied Access
Date of Visit: Arrival Time: Departure Time: r S County:
Farm Name: &CV*f 1) POINT J�C_ Owner Email:
Owner Name: Qyx--k n F&mf 'I'ne_ Phone:
Mailing Address:
Physical Address: 11:00-hL MC
Region: r�
Facility Contact: I-W Diydfn Title: L0ly,, ?)r Phone:
Onsite Representative: �U DMI�F Integrator: Pf
Certified Operator: Le w QQde4 Certification Number: lbbgs-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
R
Design Current- 3 �.� � �
Capacity Pop.�yWet, Poultry
Des g ,.,� urren
Capaty = Pop
Design Current
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Boars
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
[—]Yes
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
[—]Yes
®No
❑ NA
❑ NE
[:]Yes
❑ No
[DNA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
No
❑ Yes tR'No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Nttmber: -QQ Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes 5aNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):'
5. Are there any immediate threats t �}f�integrity of an of e structures observed? ❑ Yes No ❑ NA NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 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
allo
❑ NA
❑ NE
8. Do any of the structures 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
(2 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 allo ❑ 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 off} Wind Drift ❑ Application Outside of Approved Area
12. CropType(s): l n6�1 gf�Mfdd QCa� s-mall qyj;' 1 ny.*ieed_]
13. Soil Type(s): havullbe 4aL': ,l.
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 Callo ❑ 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
[�IrNo
❑ 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
CR-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. ayes ❑ 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 n'No
23. If selected, did the facility tail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
D NA ❑ NE
& NA ❑ NE
Page 2 of 3 21412011 Continued

'acili Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Callo ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ®-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 CAW'W?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [S No ❑ NA ❑ NE
[]Yes CRNo ❑ NA ❑ NE
❑ Yes tR No ❑ NA ❑ NE
❑ Yes CQ'No DNA ❑ NE
❑ Yes RNo
❑ Yes JR No
❑ Yes �TNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). .
SOnfle- In Dort. -Wie- ha.,,e bea, `oq, '(�- aola bud- ham
a4 4aS. Yvf l n s1t'd9ef eve Old, 03a0�ra 'o� �D� Doi kad stud,e-
Swwr �, -3 0 11 I.
vciv J (UV�JvS
i, °ut a I wil P� 5' � h'g ald�rJo but not- why
ran - &i.e small oma- —. Notim of va�Ye r��fch nar -he lg1—
C�� + g
. cat MO SV(-to
(� _oo' "OC&-d .
t A -4;�3 u�a'e P no
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: cro "z—m oQ
Date: / Ii i,-poll
21412011

Facility No. Sd- �p Farm Name &W4 0 Date
Permit —/ COC OIC� NPDES (Rainbreaker
OWN
FB
PLAT Annual Cert)
Lagoon
FB
PLAT Annual Cert)
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Actual•
®�J��-----�
Design Width
Actual Width
WAI�FA.
W#g 10f
Soil"Te�t Date �dU j vol
pH Fields
Lime Needed
Lime Applied
Cu-I Zn-I
Needs P
Cron Yield /
We ble Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Code
Transfer Sheets YtT-1—
Cead
GE7bor
incinerator ✓
ecords
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
(vo—
$o
a
rr-Dc
aIR
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 3laotgp Date last WUP at farm3)dplq�
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Iblac
App. Hardware
Rpeb

Ii ype of visit: i4q uompuance inspection v Loperauon xevtew u airucture r.vatuanon u i ecnnicat Assistance
Reason for Visit: 9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I a] Arrival Time: Departure Time: 5 County:
Farm Name: roimOwner Email:
Owner Name: �I�-Qr f"W� /YIJ Phone:
Mailing Address:
Physical Address:
Region:' FPO
Facility Contact: Lew b&dyn Title: Qwn Phone:
OnsiteRepresentative: evv MI& Integrator: &&U 4z- ^
1_/ ^_
Certified Operator: Ley 6, Q "f4 Certification Number: 16 0
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current r Design Current Design Current
Swine''' Capacity Pop. Wtet Poultry. Capacity Pop. Cat#!e Capacity Pap.
Wean to Finish La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
-'} '_ -
Farrow to Wean
Design Current
D Cow
D .. P,o.ul ` Ca aci P,o
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
HGilts
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)? `
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 fZa No ❑ NA 0 NE
❑ Yes ❑ No
❑ Yes [:]No
[] Yes [:]No
[:]Yes Ef No
❑ Yes WNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: -go jDate of Inspection:
NV�aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I Cr 1!3
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
QR-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?
15kYes
❑ No
DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ 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
NZ -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ML-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CR-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 ❑ vidence of Wind Drift ❑ Application Outside of Approved Area
j�,, / 4
12. Crop Type(s)= �� 4^"/M✓G(a7 ��> /e s-mto & jg6r''1��;rPj
13. Soil Type(s): JF&,Pt t 1IP- T,s j rn A EE�B.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J�TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
N No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
'J�j No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
54 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.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ 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 r
No
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
N-NA ❑ NE
21412011 Continued

Facili Number. jDate of Inspection:
A Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [aNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CR 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?
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
pen -nit? (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 C' No ❑ NA ❑ NE
❑ Yes 0 No . ❑ NA ❑ NE
❑ Yes FfNo ❑ 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
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
IR No
❑ NA
❑ NE
piege, 1 oi'\ e- bo, k of la oo, 1 nev- hoy haws , Small ri 11 n�4'
Vey rve[j rna,h'�ajW
Le+-R�' `For bd&uf 01 C- •
Reviewer/Inspector Name
Isr a", 00�11 M . MM, M-
Reviewer/Inspector Signature: Date: JU
Page 3 of 3 21412011

,Facility No. Farm Name
Permit COC .Z
011C Pr - -
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date Ja n
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
15-6sig—n Width----
�-----
- Width
M*R.-It
Soil Test Date Q-7' Wettable Acres L� RAI UGE
pH Fields WUP <L De d bo r incinerator
Lime Needed 6-0,7T Weekly Freeboard o a dy Records
Lime Applied 1 in Inspections
Cu-I ✓ Zn-I c1 120 min Insp.
Needs P Weather Codes
Crop Yield Transfer Sheets
.� r.
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
ass
0.
so
�
Ail
.S
- K
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 1 ! Date last WUP at farm
FRO r Farm Records 31ao{�� �
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

Type of Visit
ompliance 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: Arrival Time: .Z:/b Departure Time: Z; itD County: St a oSo.V Region: A:7"
Farm Name: tea. 5 C Owner Email:
Owner Name: Q U—a e.tr 1:;Lvrks Phone:
Mailing Address:
Physical Address: _
Facility Contact: Ctar-b`s 23ayL Jfc- k- Title: SPzG Phone No:
Onsite Representative: Integrator: Co kavKG ��-rw-. 5
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = d = « Longitude: = o = i 0
td
Design wurrent Design Current Design Current
Swine Capacity Populatian Wet Poultry Capacity Popnlation Cattle Capacity Population
rk,l o Finish ❑ La ero
Feeder
❑ Non -Layer
❑ Dairy Calf,
eeder to Finish
0 1 Z
Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -Layers ❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cow
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑ Other Dumber of Structures:
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
L`1 No
Bo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
G� A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No No
❑ 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
El No[q
,,.�,,/
A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[IL_f Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
BNo
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

Facility Number: $2 - 9 O Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 2-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Ll No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes B No ❑ NA ❑ NE
❑ Yes [R o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ETNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,��
9. Does any part of the waste management system other than the waste structures require El Yes L'_fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 3 ❑ NA ❑ NE
maintenance/improvement?
t t. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L`f'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. Croptype(s) e- Sw,e << Gvuin.t $v.wct.- £ W1Q -e- 14uuv�JS
13. Soil type(s) Fae—e-v i Ire-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Er -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
Yes
No
[al o
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
El yes
o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,B
0,90
❑ NA
❑ NE
Cotnsnents (refer to1qu'es11 i a }; Explain any YESranswers and/or any recommendations or any other comments.
s as necessary,):
Use drawings of lfaeilityto better explain situations. (ttse,additional pageMI
Reviewer/Ins ector Name¢`} : ' °' , • ke
p lK <'v15 Phone: ql 33, 330 0
ReviewerAnspector Signature: . Date: /-a g ` 2010
12128104 Continued

Facility Number: $ 2 — 9 Date of Inspection 1
Required Records & Documents �,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Lf No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes lJ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D o ❑ NA Cl NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[B o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,Lg,gl'o
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
,ISNo
L74o
❑ NA
❑ NE
Other Issues �
28. Were anv additional problems noted which cause non-comnliance of the hermit or CAWMP? ❑ Yes B No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L+fNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
/
B No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�.,,�
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L'�"No
❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
ElE Yes
o
❑ NA
❑ NE
12128104

-rhi S /o —05'— Za 0 9
Division of Water Quality
Facility Number $z 9� 0 Division of Soil and Water Conservation
Other Agency
Type of Visit ompliance 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: q �� �49 Arrival Time: Departure Time: County: gr- g2� O Region: r-12V
Farm Name: elck,r' 1>_ �' YES _ -+��' ' Owner Email:
Owner Name: QCLan6=t:�: -:I> 1� Y+r. �S Phone:
Mailing Address:
Physical Address:
Facility Contact: t^llr4a Title: I -a • Phone No:
Onsite Representative: Integrator: Ct,LIn C S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 6 =is Longitude: 0 ° 0 I = u
Swine
Design Current . 7, i Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Nan -La e►�
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
yZQ
/ O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ ufkey Poults
❑ Other
Discharges & 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?
Design "Current-'• r
Cattle Capacity Population :,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
-
Number of Structures:'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
L� NA
❑ NE
❑ Yes
❑ No
ERINA
❑ NE
E�k A
ElNE
❑ Yes
No
El Yes
,❑,,
L_7 <
El NA
ElNE
El Yes
[2 o
El NA
El NE
12128104 Continued

C i
Facility Number: 82 — 90
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [R o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L`i'No ❑ NA ❑ NE
Structure(o Structurco Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 a
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes EEK ❑ NA ❑ NE
❑ Yes aK. ❑ 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 L7No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No [:I NA [I NE
maintenance or improvement?
Waste Application //
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes BNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
B Vo
❑ 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) R&vv - u.1tra."o C /O, S •J Sc�..�ctw.<.r .► u-
wr 3
13.
Soil type(s) FQG. W i 4-
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
BNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
07 No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
3<o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
L7 No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
2<
❑ NA ❑ NE
CVOOd �_0 U W_ 0 nt /ckSfM n/S ,
Reviewer/Inspector Name Phone
q/o. �(33. 3 3
Reviewer/Inspector Signature: avG-� Date: —/li -21_6,0g
Page 2 of 3 12128104 Continued

f _ 4
Facility Number: 82 — 0 Date of Inspection
Re uired Records & Documents //
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes M o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B No ❑ NA ❑ NE
the appropirate box. ❑ Wup [] Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections E]
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
ElYes
E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER<o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
, to'
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ECJ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes LI No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ to ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
l+'No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ffNo ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
,.,/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El yes
[9 No�❑ NA
[I NE
33. Does facility require a follow-up visit by same agency?
El Yes
E No ❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit 0 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: /3'08 Arrival Time: Departure Time: 3: ZU County: , .57f'-.e_ '0AJ Region: "I
Farm Name: Q. LCXY4C4- D. rCV-15 Owner Email:
Owner Name: Lew (;'I boy'4c i Phone:
Mailing Address:
Physical Address:
Facility Contact: CuvIr4siGK Title: 1 ¢�-L sj4et . Phone No:
Onsite Representative: integrator: Co"'le— F--Cxt'f"" 5
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = d = « Longitude: = o = 6 =
it
Destgq Current Destgn Cnrrent
'0'ffi
Design Current
Swine
Capacity Populattiit` WeEtllu_gapatitup6lation
Cattle Capacity Population
❑ Wean to Finish
❑ La er
Dairy Cow
❑ Wean to Feeder
-Layer
❑Dai Calf
[� Feeder to Finish
�w
3WZD 3320*
El Dairy Heifer
❑ Farrow to Wean
x Wiz,
Dry Poultry .- �.-
❑ D Cow
❑ Farrow to Feeder
""`'""� "`
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
El Turkeys
Other ?❑ TurkeyPoints
_
❑ Other �, ❑ Other
Number of Structures: 2
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
DIIIII
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
ElL7 Yes
�, I
No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
ElLEI No
[❑1
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
El No
/
EI NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VOA❑
NA
[3NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,3
D<o ❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

M �
Facility Number: $2 — C1 Date of Inspection
Waste Collection & Treatment ,.�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes LI 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): Zg _ 32-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
2No ❑ 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
Q N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [I 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 El Yes
L_< ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ElYes
�
2<. ❑ 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. Croptype(s) (&,:j� $.,.►�!% G,,,; ► Suwra�cg— L. #j4c-y f�nrmA&I3'
a ;
13. Soil type(s) F ac
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No ❑ NA
. ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
��No
❑ NA
❑ NE
Reviewer/Inspector Name
s C_K i�zeve Is.
41Phone:
9/0. $133.333Z7
Reviewer/InspectorSignature:
vela/
Date:
g—i3 —ZOOS
rage 4 of -3 u1.001v4 wnunuea

Facility Number: gz — iD Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections O Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L' No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes
Et< ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6N"o ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ld'I`io ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
31N.
❑ 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
[3 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2No
❑ 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
ErNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Cornments and/or Drawings
Page 3 of 3 12128104

Type of Visit m Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S /O- Duo Arrival Time: Departure Time: County: Scan/
Farm Name: Qu-a-1r+cy- D Farms.` Owner Email:
Owner Name: Q ydenJ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Cuvi`3 BGiyWi'c,,- Integrator: CO katrii 0.
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] o ❑ ' ❑ « Longitude:
Region /=�eo
Design
Current
Design Current
Design Current
Swine
Capacity
Population Wet Poultry
Capacity l'optulation
Catu Capacity Population
El Wean to Finish
❑ Layer
El Dairy Cow
El Wean to Feeder
; ❑ Non -Layer
El Dairy Calf
Feeder to Finish 1372
D
2 7
`Dry Roultry "
t
El Layers
�°�
„r _,° ..
❑ DairyHeifer
El Dry Cow
- ❑ Non -Dairy
El Beef Stocker
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
Gilts
ElNon-La ers
ElBeef Feeder
PO Boars
❑ Pullets
❑ Beef Brood Coyd
Other
^
❑ Turkeys
x
❑ Other
, � rwa
❑ T urkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes P No ❑ NA ❑ NE
❑Yes
[PNo
❑NA
ONE
❑ Yes
[A No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[4 No
❑Yes
PNo
❑NA
FINE
❑ Yes
[XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: $Z— 110 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 - Structure 2 Structure 3 Structure 4
Identifier --
Spillway? -
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑Yes ENNo El NA ❑NE
❑ Yes R) No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes ®No ❑NA ❑NE
❑ Yes M No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® 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
JO No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R] 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) CX lM� G. G�� S -1-a/ Avm" S -✓
i 4"
f
�,1 y
13.
Soil type(s) FaGLi]i
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
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;[:]
Yes
CANo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0 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 answers and/or any recommendations or any other eoEruz c.
Use drawings of facty tp better explain situations. (nse additiional pages as necessary):
Reviewer/Inspector Name '' {t C5`, , , Phone:
Reviewer/Inspector Signature: 'Z�1� Date: —/O—ZED
12128104 Continued

h
Facility Number:''Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [NNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[M 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
M No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JM No
❑ NA
❑ NE
12128104

SPUS 6." Q. E.u/t rS
Type of Visit Q',C,ommpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
t3
Reason for Visit koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1'9-0-071 Arrival Time: A*35—Departure Time: Z; 30 County: 50AI Region: /e--kO
Farm Name: 19 Wtedez �"�rL+.s�: �N�_, Owner Email:
Owner Name: L c `"� l7ar� Q n I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Cu"-5 Stx y t...] t [_
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 11- _a y e, C
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = =, Longitude: [= o [� g =
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry
@apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
El Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
21 Feeder to Finish
Z d
�' �'
',-
❑ Dairy Heifer
❑ Farrow to Wean--
Dry Il'ouitry r
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
�= Pullets
❑ Beef Brood Co
�`'
❑ Turke s
.
Qther
❑ Turkey Poults
❑ Other
❑ Other
T
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[51 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
[7No
❑ 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
[4 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[jNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility lumber: $z — Date of Inspection 8'09`07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �A 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 f� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
59 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2PNo
❑ 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
P 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
29 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
E4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

i
Facility Number: $Z
Date of Inspection -[1 9 -O 31
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E6 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
PrNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 i Q q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
IF
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
P�No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[j No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1� No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
WNo
❑ 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) &CK,,cl jr,,;.,t/Ce L 5Ma//
13. Soil type(s) u
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
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�fl No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
CM No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[,3No
❑ NA
❑ NE
;Comments (refer to question #f): Explain any YES answers and/or any recommendations or any other comments
-all
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ! j ,�� �� Phone: 9/0. �f a
Reviewer/Inspector Signature: Date: $ -0 — 2-00-7
Page 2 oj_3 12128104 Continued

F,
_ _- � Division of Water Quality IN
iEWHOty Number a �jpA
O Division of Soil and Water Conservation
M Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit- 3-j Os~ Arrival Time: : YS Departure Time: County: .517Region: 00:�10
Farm Name: e /ar-lfer^ Q dr2zeirig ; fin[ Owner Email:
Owner Name:. Qrie.lrr, Q - Fed%5 Tnr _ _ Phone: 2ZQ-,5-4-41 - —>1.3 9
Mailing Address: _ 5 __ taj/ Rai c 93V
Physical Address:
Facility Contact: C�'•�terK1L 1(( Title: Phone No:
Onsite Representative: �Ilkl 19a1....�/r. M1Pnlc,.. G Da..,/,,._ Integrator• r < 1iQe-i,e
Certified Operator: Lem. D41-Am Operator Certification Number: /G G T "
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o [� i [� tt Longitude: = 0 0' = "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population.
❑ La er
T ❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Other
❑ 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 than -made'?
Design Current
Cattle Capacity Population,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: EQ
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 [9-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P-No
❑ NA
❑ NE
❑ Yes
BNO
❑ NA
❑ NE
12128104 Continued

Faeffi Number: `!
h' — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: /1 r, 00
Designed Freeboard (in):/
Observed Freeboard (in):�S
El Yes QRo El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Oo 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 ❑'Fio ❑ 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
k^a
7. Do any of the structures need maintenance or improvement? Yes OpFio ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
D <io
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
G; o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(91<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
9lo
❑ 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
// s 6-sr
12. Crop type(s) 6tl.- l 4j7nceAj j6pr, #4n^vmlQtr
s�
Sr,�/
13. Soil type(s) Fa., V j/&
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2&o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Mlo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
❑ No
❑ NA B'NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA CONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
❑ NA ❑ NE
7 P/ea.se Work to es�ni/.;�( J L f
9oe GfrasS Gourh d�1 �r Grta.f 7�0 �O�t✓e.. C/'vS.�i. �/G�sC
%hAW Ale ltidsJy Su�l'ng S �><o fire { 7�ta /u9oen LOn�y a %„ warJr S'f"+�3
Reviewer/inspector Name ,frl� - �'' ''`' Phone:
Reviewer/Inspector Signature: Q Date: /g-Ot
f L/LO/VY l.v/[[{[["Cu

Facility dumber: jq.2 — go Date of Inspection
Required Records & Documents ,,---,,��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D'1qo— ❑ NA ❑ NE
the appropirate box. ❑ ❑ Ch5peists ❑ DeW ❑ MpK ❑ OtkK ,�.,,�
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes [; o ❑ NA ❑ NE
/7,/,9 la-w �i.g,�G io-,sir s,,,�
El Waste Application ElWe�ard El Afaste ❑ Seii-sis ❑ s ❑ em ication
❑-Tl;aittfa}1 ❑ &ae6❑ emrrmtt ❑ nu ❑ wo"4w4e&�
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? (iel discharge, freeboard problems, over application)
32- Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33- Does facility require a follow-up visit by same agency?
❑ Yes
[9'110
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
D-No
❑ NA
❑ NE
❑ Yes
E?qo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
alIZE
❑ Yes
Q-To
❑ NA
❑ NE
❑ Yes
U-No
❑ NA
❑ NE
❑ Yes
0-go
❑ NA
❑ NE
❑ Yes
O'iQo
❑ NA
❑ NE
❑ Yes
[2-Ro
❑ NA
❑ NE
❑ Yes [j}<o ❑ NA ❑ NE
Ak ditionahComments aadlor Drawliags:
12128104

Type of Visit OXBGmplianc pection O Operation Review Q Lagoon Evaluation
Reason for Visit outine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ate of visit: E�Z i Tune: b
Q Not O erational Q Below Threshold
0 Permitted 13 Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 0061— S ..._------------------ County: ._.
_..........................
q q
Owner Name: . 4 Phone No: I
... �'...._ _ . - -._ _ ........ _....b. _. .. ...._. _....
Mailing Address: ..... ._.........'?`t... .....IYC
Facility Contact: ._ Title: Phone No•
. Q� _�S
Qnsite Representative: C-W
.....................!-r.."'.......__............................................ Integrator: ..._._...�--a_'�.-r'�........_.....................--------
Certified Operator:.-......_. Operator Certification Number:
Location of Farm:
O's"W'ine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude ' 4 61
Swine {
Design'
- Caisacitt* c
Wean Feeder
=:
Layer
er to Finish
Quo
Non -Layer
Farrow to Wean
Farrow to Feeder
Outer
Farrow to Finish
TOW I3eSij
- "7
Gilts
El Boars
Number a Lagoons
1.
Discharp-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
<`L Nan-DairyI
P2'92FITM_
i t T.
6tw SSLW
�K
"Y
❑ Yes Miqp
❑ Yes [--]No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes BM--�
❑ Yes Q•Aia�
❑ Yes
Structure 6
Identifier: .......... . ........................ ..............................
Freeboard (inches):
12112103
Continued

Facility Number: 8 a — L) Date of Inspection rJ
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes [j No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 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 maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes r No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑'1VO
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ElYes aQ
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �.�r , Lm4er CD,�r_i P Jl,;1kq , t
13. Do the receiving crops differ with those designated in the Certified Animal
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Management Plan (CAWMP)?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 0416
❑ Yes io
❑ Yes 94<01
❑ Yes G4qo
❑ Yes �Z�'
El Yes No
❑ Yes No
❑ Yes OW,
❑ Yes [ado
❑ Yes orNo

Facility Number: — p Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? �__/
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes amo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Cal
❑ 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
o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M-N�o
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
M.No'
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Leo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
3
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
��Xo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
21es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes EPhr-
33.
Did the facility fail to conduct an annual sludge survey?
es
❑ No
34,
Did the facility fail to calibrate waste application equipment?
es
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
M4d'6—
❑ Stocking Form [:]Crop Yield Form ❑ Rainfall ❑ inspection After V Rain
0 Minute Inspections ❑ Annual Certification Form
o violations or deficiencies were noted daring this visit. You will receive no further correspondence about
this visit.
12112103

Site Requires Immediate Attention: NA
Facility No. - ao
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 'I I z.o , 1995
Time: L o 4 Z-
Farm Name/Owner: _ _ Q •�a �� t-
Mailing Address:_ R-� ��x ZZ - �� _ N �._ Z�' K
County:
Integrator: a.. ' Phone: SA-1, - o to S
On Site Representative:_ � � a�� n - Phone: T& 4 - Z %-3a
Physical Address/Location: N 'M c- -k y --,L k+ c. F. �., s
Type of Operation: Swine
Design Capacity: 30,zo
K
Poultry Cattle
Number of Animals on Site: 3g z o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0 Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm
(approximately I Foot + 7 inches) Paggoon(s)?
or No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the Yes or leo Was any erosion observed? Yes o No
Is adequate land available for spray? Yes r No Is the cover crop adequate? Qesor No
Crop(s) being utilized: to Ge,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwel
No
event
100 Feet from Wells? Yes o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(lo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes org
Is animal waste discharged into water of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate was management rec s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Z
Inspector Name
Signature _
cc: Facility Assessment Unit Use Attachments if Needed.

E=7GI5TRAi:0N FORM FOR ANIMAL FEEDLOT OPr_RATiONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be f-''_led out and mailed
by December 3L, 1993 pursuant -o 15A NCAC 2H.0217 (c) in order to be
deemed permitted by OEM. Please print clearly.
Farm Name: U/f 2
Mailing Address: ,Qt A, [ja -6
�..� �. ZIP 934i
County: Phone No c,ic -51PSL
Owner(s) Name: .CrW ��. �r�r'�rrF-✓
Manager (s) Name:
Lessee Name: N4
Farm Location (Be as specific as ossible: road name] direction,
milepost, etc ) I._ - t71� /l1 �^,lf�.,-' TZ r►�; 1� rL•^-
Lat_tude/Longitude if known:
Design capacity of animal waste management system (Number and type
cf confined animai (s))
Average animal population on the farm (Number and type of animal (s)
-raised) _. 3c>c f4-,
Year Production Began: 7 - c G ASCS Tract No.: �: �• -�
Type of Waste Management System Used:- �-•-ac'-sr�..q�,:-,
Acres Available for Lan��'\
nlicatio of Waste:
Owner s Signature s .�. l DATE: 11-lo-7 3
DATE:
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