820094_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

�—
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2-/9- 0 Arrival Time: /�'7y' Departure Time: /D.JS� , _ County: sow Region: rzo
Farm Name: Pork CA-02��� Owner Email:
Owner Name: �J///a _ Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: –1651"Ll, y s Phone No:
Onsite Representative: N, e OU oN Integrator: 1 D r
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1 = Longitude: =O=S
n=S =
10 1Design Current
Design
Current,x I Design Current
Swine �Capa.ct�tyPopulation
Wet Poultry Capacity
PopulatioaeCatilef '�' Capacity Population
❑ Yes
❑ No
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean 2000
-ro P x 'x
D . Poult - " °-� ❑ D Cow
El Farrow to Feeder
[_1L� Yes
� ❑Non -Dai
❑ Farrow to Finish
❑ La ers
a
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
�. E] Beef Feeder
❑ Boars
❑ Pullets
,:
❑Beef Brood Cot—
oTurke
Qther
s
❑ Turkeys
❑ Turkey Poults
❑ NE
❑ Other
❑ Other
x�a
r Numbe1�bf Structures:
Page 1 of 3
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes L7 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EE3-NA
t,, KA_
❑ 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)
[_1L� Yes
❑ No
�,,�
1vA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0-5—o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: �� 4
Spillway?: /1�d
Designed Freeboard (in): 19
Observed Freeboard (in): 2-5-
5.
S
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 E No ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 1J No ❑ NA ❑ NE
❑ Yes 2'1 to ❑ 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? El Yes B i o E] 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 El Yes t3 Na ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ETNo ❑ NA ❑ NE
1 I_ is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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) evd (�7 r Gam; �� Sw�a Ci' (5rA� ,J �a , S
I3. Soil type(s) /v o A W Q g
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CJNo [I NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E Ngo E] NA [INE
16: Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ElYesL0-1
'f Ngo [:1 NA El NE
17. Does the facility lack adequate acreage for land application? [:1 Yes LTNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
P �Ti �S Phone: `?/a, 5 33 , 333 O
Reviewer/Ins ector Name � �, 0 ev,
Reviewer/inspector Signature: Date: /Z —/i— ZGd
6 1
12/28/04 Continued

Facility Number: $Z Date of inspection
Required Records & Documents CI'
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L7 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0-1�o ❑ 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 fait to install and maintain a rain gauge?
❑ Yes
El NA
El NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,D'lvo
L'I Ngo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
o
[__1 NA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElL7 Yes
,0
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
is No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0<1❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.,
! 1- o
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
2 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
D -Igo
❑ 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
El Yes
,—, ,�
Imo
❑ 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
,--�
L31vo
C1 NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D -No
❑ NA
❑ NE
Comments and/or Drawings:
12/28/04

b�rMS enfr-O—cal /Z/olv /Zda -7
® Division of Water Quality
Facility Number g2 ql�C 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: :304*.*, Departure Time: //,SBD jw County: SAJUOSo.A/
Farm Name: Pit&Owner Email:
Owner Name: ItAl //� � ,4,/ KIs-✓i.VQ Phnne-
Mailing Address:
Region: /=40
Physical Address: %
Facility Contact: Title:-A5VL-. 111Bi-Phone No:
r_
Onsite Representative: MI., _ Integrator: >�/// �QkJ'4 _
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =' =' ="
Longitude: [=] ° = ' =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design.-- - Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
i
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
12/28/04 Continued

Waste Anotication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
It. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(9No
❑ NA
❑ NE
Facility Number: —
Date of Inspection
T8 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Me
Waste Collection & Treatment
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O No
❑ NA
EINE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
Cl NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
.r
Observed Freeboard {in}:
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[� No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
{
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Of 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)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Anotication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
It. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T8 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Me
Cl 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
PA No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
iewer/inspector Name ic_ I'. Z, rVC `5 Phone: 9/w, �3�- 33oo
E
iewer/Inspector Signature: Date: &7-3/— ZC70-7
12/28/04 Continued

Faciiity Number: gZ — 9 Date of Inspection �4 3i—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1� No ❑ NA EINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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
V'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1� No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

B Don MENU Water Quality
EFacility Number g� - 9 3 Q Division of Soil and Water Conservation
Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:S z �{o Arrival Time: Departure Time: /Q,3� County: _ �_� Region: C20
Farm Name: Po yk C v/ Owner Email:
Owner Name: /✓e Gary,- Phone: 9/0..S9l�. '02/1
Mailing Address: p0, go< 3raa
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =c Longitude: =0=1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [A No ❑ NA ❑ NE
❑Yes
VNo
❑NA
EINE
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
IEJ Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer
❑ Dai Calf
❑ Feeder to Finish
ONo
❑ Dairy Heifer
Farrow to Wean ZaOD 7r0S0�
Dry Poultry
❑ D Cow
El Farrow to Feeder
❑ La
❑ Non -Dairy
❑ Farrow to Finish
ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
El Beef Feeder
[:1 Boars
El Pullets.
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ 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 [A No ❑ NA ❑ NE
❑Yes
VNo
❑NA
EINE
❑ Yes
V No
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
[�j No
❑ Yes
ONo
❑ NA
EINE
❑ Yes
[RNo
❑ NA
EINE
12/28/04 Continued

Facility Number: $Z— 9y Date of Inspection jr— Za-0&
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 7 AF
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[INo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[;WNo
❑ 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
R No
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ONo
❑ 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
[TNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) Cv,=
13_ Soil type(s)
14. Do the receiving crops differ from those designated in the CA WM P?
❑ Yes
2I No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2rNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�y No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q�No
❑ NA ❑ NE
5
Comments (refer to question #}: Explain any YES answers andlor any recommendations or�aayxotments
`Use drawings of..facility to better explain situations. (use.additional pages as necessary):
Reviewer/Inspector Name j �1Gk ��N Phone:
Reviewer/Inspector Signature: Date: $ �Z �ZpC (Q
rage L of s UIZ510¢ Lonnnueu

Facility Number: $Z — i Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [YNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes [�No [--INA ❑ NE
the appropriate box_
❑ WUP ❑Checklists El Design El Maps El Other ,,��,,//
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LdNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ 4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I 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
Q�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EWNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ 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
P No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9rNo
❑ 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
CgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PfNo
❑ NA
❑ NE
and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: }Arrival Time: r : p0,��.� Departure Time: � County: �a+. j+_� e«� Region: F-160
Farm Name: ■Pork ft_0.V 1 . j I Owner Email: f
Owner Name:-IV_e.� �'o K e rav a 3 �� Phone: 4 10 - �f - o.� 14
Mailing Address: P 0 130 Sob +-O. e L°
Physical Address:
Facility Contact: 2 -o -c Tt+c �. o...� Title:
Onsite Representative:a�.,N�
Certified Operator: 'DO-U-!;IMI.19h d.d
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish I
Q Farrow to Wean Avo u al000
t
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
i
❑ Boars
Other
❑ Other
Phone No: ? 10 - 6-10 - 4/32
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 =1 =" Longitude: 0 ° =' ❑
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity -Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

I�
Facility Number: Z — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility tail to have all components of the CAWMP readily available? If yes, check ❑Yes ©No ❑ NA ❑ NE
the appropirate box_ ❑ WU, ❑ Checklists
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ER No ❑ NA ❑ NE
❑ WasieAppliCatinn ❑ weekly Freelerti-- ❑ `1 Anai•Tsi$ ❑ Semi sis ❑res ❑ Annual Certification
❑ ka44� ❑ Steckiifp ❑ Czop-Yield ❑ 120.Uinkite is9f;vGt:H ns ❑ M ❑ V4ut ht-r4ode
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
m 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
Q9 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
®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 tail to notify the regional office ofemergency situations as required by
❑ Yes
®. No
❑ NA
❑ NE
General Pen -nit? (ic/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EN No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/28/04

Facility Number: ¢� —t L,Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes © No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13- .may ''
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes®No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [K 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 Q No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 21 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) �P(., _14g.-, i�e�-yc{ � C1✓4a� ��� .•+cJ�
_
13. Soil type(s) Alp /T fjA B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
© No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
Z No
❑ 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
Q No
❑ NA
❑ NE
jEdA
fer to question #) yoE pA'Ia AranyY)JSJ4answer�s:and/or=ahy�recommendations or aay other commennngsofacllltj to beEtereYplatn sihlatlans..(use adrhtlonal pages as necessary)•
Y
3� 7'�•�'I/tf �r�..r:...� I�^f• �4d.�-� 67r..Gf.cr.►, PY/t�[ECr•4iir.t ya-�ct��s..s-e- L
�r'aG k..e.v5 a �u fle � �t�i�.. .� refc�a.. ru i f4. se ...< < Cray; -� . �/�-sr %i.a..-t T�•'r
Reviewer/ins ector Name '� T
v
p FS
., 4 Wl�- a w,; Phone: —!3 3Y
Reviewer/Inspector Signature: Date: a_—Al
12/28/04 Continued

Type of Visit QrCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit (�/Rovtine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: - 00 1 Time: S si a
Q Not Operational Q Below Threshold
0 Permitted [3 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ... . - --• •--•--.
_ ' f
Farm Name: ....._ . C'"� �s:!'3 ...W- :' + 4 �hL __.— °„ County: ._.. Er! ------ -----
_ _ ......_.
'r _...._� .._....
Owner Name: X41` A'Agn........ {�•*�► q I:i4j.. . Phone No: ... 9/D --S94 -0°2./q_...._ ................
MaiilingAddress:
Facilitv Contact: lameµ �c i w ............_......... Title• A... 4! L4_... - - .. Phone No:-
_... - - -
Onsite Representative ....... ��4�,..._. /`� N",,.�ew� _ .. _ .� .. Integrator:_ 7_N'I _�. ._....__.—__-
Certified Operator:._........ ��µ %I�sc.•�wr.c� _... Operator Certification Number:,_ji
...1.}......._._....�_ - �_.��.....__.._..._.
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 it Longitude ' 6 it
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes Q(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes G~ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [y'To
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes &N' o
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure b
Identifier:..
...., ...... .__......... ....._.. _.- - - --................ -.... ...... .....
..._
Freeboard (inches)- 'y
12112103 Continued

Facility -Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type l_,oaS4J_ S"01 WA:4a 6urtcie_eA
❑ Yes PNo
❑ Yes [f No
❑ Yes ET&o
❑ Yes Bfgo
❑ Yes Egfio
❑ Yes C3' 40
❑ Yes Bf4o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes two
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ER<o
b) Does the facility need a wettable acre determination? ❑ Yes EBT4o
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?
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 BNO
❑ Yes ff No
❑ Yes B'No
❑ Yes ['lo
❑ Yes 2rNo
❑ Yes ['No
❑ Yes ["No
Comment (refer to gmestioa #) Ei�plaut YE5 answers,aad/ar any reeamme�at>woAs ar anYjott er coari�eats. `_. _ '
Use drawutgs of fac�ty to better explain sttu%vft . (ase addittaaa! pages as necessary) eld Ca El Final Notes
ti wM�q z
�r
F{cd5
` !J 1a�1
Reviewer/Inspector Name 7-_ r
Reviewer/Inspector Signature: 4AL ifeDate: �' D
.12/.12/03 U Continued

Facility Number: Date of Inspection 7
Required Records & Docurnenu
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! W UP, checklists, design, maps, etc.)
23. Does record keeping needimprovement? If yes, check the appropriate below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 93 -No
❑ Yes Q'I10
❑ Yes BNo
❑ Yes B No
❑ Yes GaVo
[:]Yes R No
❑ Yes Bf4o
❑ Yes L J No
❑ Yes BfNo
❑ Yes [�Io
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
A.
JJ
New 4"h
i&
a„+ &O i'
J
12112/03