820096_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

I ype of visit: (a),Compliance Inspection V Operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: all outine • 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j�lvhac� Arrival Time:ll-[1-!l--i Departure Time: K S County:
Farm Name: i��t3 Fa.f!_VC Owner Email:
Owner Name: CL f Phone:
Mailing Address:
Physical Address: Facility Contact: Cu 5 l77
a,;" fi✓f �r Title: Phone:
tL
Onsite Representative:
Certified Operator: AlAw
Back-up Operator:
Location of Farm:
Latitude:
VwToN Region:
Integrator: ff _'>
Certification Number: 0— ©Xb 7i
Certification Number:
Longitude:
- Design
Current
Design
Current
Design
C*arrant
Swine Capacity
Pop.
Wet Poultry
Capacity
P.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish
-7
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
l) , l;oul
Ca aci
P.o
Non-Dat
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Lavers
Boars
Pullets
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Q_Ncr- ❑ NA ❑ NE
[—]Yes
[]No
NA
❑ NE
[:]Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ETNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes rj No ❑ NA ❑ NE
of the State other than from a discharge?
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 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ISl"f' ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E 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
Eql<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�fo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Mdo
El NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E],,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P-I�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E . ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C . 6 PGL We, v-e. S G r;�
❑ NE
13. Soil Type(s): Lie
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ENo
❑ NA
❑ NE
V.
Does the receiving crop and/or land application site need improvement?
es
o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
[3*lZo
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Re
uired Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ io
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available'? 11-yes, check
❑ Yes
F3 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 12<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes E No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No 0 NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - Date of Ins ection: ZI/ M19r,`
24. XDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I o ❑ 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: 3,
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [�l�o 5y❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes To ❑ 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 &]Wo ❑ NA ❑ NE
❑Yes [�Ko ❑NA ONE
❑ Yes [4Ko 0 NA ❑ NE
❑ Yes E�J❑ NA ❑ NE
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
[: No
❑ NA
❑ NE
❑ Yes
[ No
❑ 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).
t4I,
Ue4I`^r y Pie <;4aiJ d, SP
-"-r
6-eAC
Reviewer/Inspector Name: �� t b� Vvi+
Reviewer/Inspector Signature:
Page 3 of 3
Phone -- `{ 3 3-33 3 `(
Date: wy dw Q
21412015

'Type of Visit: m ance Inspection O Operation Review 0 Structure Evaluation 0 Technical 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: County: S Region:
Farm Name:MIK1� _f `�ir/`l� Owner Email:
Owner Name: iuoKrkpt if Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 Title: Phone: /
Onsite Representative: Integrator: /'I 0
Certified Operator: INh ro-e way Certification Number 0 &L o
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current,
Design Currents Design Current
Swore
Capacity PoL
p
Wet Poultry
i Cattle Capacity Pop
Capacttvl ap
¢f
IL
La er
Non -La er
ti
Dai Cow
Da Calf
Y
f
s
Dairy Heifer
�r
_
r
Design Current D Cow
I)r, P,oultry
Ga actPo Non -Dairy
_
La ers'
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
TurkeyPoults
Other"
>�
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharp_es and Stream Imuacts
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 �tf ❑ NA ❑ NE
❑ Yes
[:]No
[�A
❑ NE
[:]Yes
0 No
EJ 1'5AA
❑ NE
❑ Yes [] No
❑ Yes F::f'No
❑ Yes dNo
[31JA ❑.NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/2015 Continued

Facility Number: Ci', I Date of Inspection: 1 7 g,"+
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes qo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ETINZA ❑ NE
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?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes �To ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
/eNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ENo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
! No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[7] N
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes OIo ❑ 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 ev"& �{ S 0 G/r-, -a-
13. Soil Type(s): CA(t 6e-C 6i.k
14. Do the receiving crops differ from thostdesignated in the CAWMP?
❑ Yes
©'1Qo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FZT"Ko
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
glo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'fro
❑ 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
❑ 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 [I No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 13<
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: ,r•
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z -M65 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'90 ❑ 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 EINO ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
dNo
[] NA
❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
[D Yes
E]No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑''No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑1No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
[] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E'No
❑ NA
❑ NE
Comments (refer to:question.,ff): Explain -any YES answers and/or=anykadditional recommendations or;anyjother�coinniiefi&l
Use drawings of facility to better explain situations (use additional pages as necessary).A
Reviewer/Inspector Name: t
Reviewer/Inspector Signature: 4
Page 3 of 3
Sri-
Phone �� t,!! 333
Date: 2? l
21412015

Type of Visit: mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: fQ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �U Departure Time: County: Region
Farm Name: lrl �Ctf Owner Email:
Owner Name: ` K t)A ; Phone:
Mailing Address:
Physical Address:
Facility Contact: . C'4 K Ids '( ca"" Title:
Phone:
Onsite Representative: ii Integrator: ►'y L7- -s
Certified Operator: 4W190- Y'l a6 t Certification Number: ?-6) 0 t3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
dc..4 '4- �-" � ( 6dIS-tI AZ�ol PG- oleo
r
Design Current _' Design Current Design Current
Swine Capacity Pop ��Vultry^ Capacity Pop Capacity Pop.
cattle
a
Finish
[Layer
Da' Cow
Feeder
Non -La er
sDa'
o Finish 20
S
—DairyCalf
Heifer
o Wean
rFarrow
Design Current
Dry P ul Ca aci P,o ..
�i 11
.- .�
'a
D Cow
o Feeder
Non -Dairy
o Finish
La ers
Beef Stacker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cl
Turke s
Otber -�
Turke Poults
Other
Other
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes Q 1�E] NA ❑ NE
❑ Yes []No
❑ Yes [:]No
[+ <A ❑ NE
2VA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No E 'NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑-1 o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

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):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑i •#G— ❑ NA ❑ NE
❑ No J�>A ❑ NE
Structure 6
❑ Yes L-4j ^40 ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
f. o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[&M
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J;�<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ea.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes
g.No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (g-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% 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): : 6 0
13. Soil Type(s): C -A i`n(^ 1,aw-bee i.✓a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ca,<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
B<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
QTo
❑ 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
❑'110
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
FKO
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C:J,IQo
❑ 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 e No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faciliq Number: 6- Date of inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F�-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q-bkr ❑ 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 [;I -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
❑ Yes Q 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 [J C o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 0 o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes ®'No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
es o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [�14o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes eN o ❑ NA ❑ NE
- �.-_ .
Comments refer to p y y additional recommendations or any otlier comments
( question ): Explain an YES answers and/or an adds
Use drawings of facility to Better explain situations (use additional pages as necessary).
,
C41rjio'1
$(ajej�rjyrl1� �-,�17-I S � �i.�- f -�r2- Rik
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
lw�
Phone: ' 3-5
Date: "V412
�

type of visit: 6m=Outine
ance Inspection V Vperation Review U Structure Evaluation U Technical Assistance
Reason for Visit: O Complaint O Follow-up 0 Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Timer Departure Time: Qc7 County: Region:
Farm Name_ Owner Email:
Owner Name: 6 r�,/�, r%`6,[G L Phone:
Mailing Address:
Physical Address:
FacilityContact: � 4 V'Cr t e(! Title:
Onsite Representative: tr
Certified Operator: 0 AA rp-c R C S
Back-up Operator:
Phone:
Integrator: yk(
Certification Number:Q
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Eapacity Pop.
WetAPoultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
Non -Layer
Dairy Cow
Dairy Calf
Feeder to Finish j
Da' Heifer
Farrow to Wean
Farrow to Feeder
D . Po_u!t ,
Design
Ca aci
Current
P,o P.
D Cow
Non -Dairy
Farrow to Finish
Gilts
Boars
`
Layers
Non -Layers
Pullets
Turke s
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes El -Nu— ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [] No
E 6A ❑ NE
NA NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No eNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes L.id"''o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [ffNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facifi Number: Date of Ins ection:
Waste Collection & Treatment
4As storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QD-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
B "" L__I 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
EJ-Na—❑ 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
Q-N;a— NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E]-Ne•- ❑ 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
D-Nw- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑-M-5-0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0-N° ❑ 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): i- f O
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
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?
0 Yes ®No
❑ Yes LI 1"o-
❑ Yes LD'T�0-
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ldl1'o
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 10
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑Other:
21. Does record keeping need improvement? If ycs, 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 Z� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[::]Yes dNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E 11o' ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo— ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EQ--Mo ❑ 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?
Reviewer/Inspector Signature:
Page 3of3
[-]Yes [ o ❑ NA ❑ NE
[-]Yes [a -No ❑ NA ❑ NE
❑ Yes E3156 ❑ NA D NE
❑ Yes O'No ❑ NA ❑ NE
[:]Yes 0 90
❑ Yes Ef'No
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date: 1-1 &,�_ 1 .5
2/4/ 014

Type of Visit: (3Tampliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: A@rlfioutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: `�' I r� Region `J
Farm Name: f'7 A ft_ � Kt C-4 4
Owner Email:
Owner Name: 6vy_ T-t ry 4ly-- Phone:
Mailing Address:
Physical Address:
Facility Contact: f 13 4V-0 L Title: 7-;A Y Phone:
Onsite Representative: < 114 < Integrator: '"
Certified Operator: Ar. Lo 13 Certification Number: �V�6O
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
:.
Design
Swine _ = CaparityE:..,Pop.
Wean to Finish
.
Current Design Current Design Current
Wet Poultry � Capaic�tV�p4p• Cattle Capacity Pop.
La er airy Cow
-Layer Da' Calf
Da' Heifer
k Design u rent D Caw
D . Point k Ca `acl Non -Dairy
La ers Beef Stocker
Non -Layer Beef Feeder
Wean to Feeder
Feeder to Finish
Fa to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Qther =
Other
Turkeys
Turkey Points
Other
Di_schar eg s and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EK0____❑
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
EID-iK- ❑ 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
Eal o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
F: j'*No
❑ NA
[] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412011 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
.47 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No QlA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d` J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E34icrNA
❑ 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
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
to ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a, ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
E3-< ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E 5_o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
U "'v ❑ 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
��-4ek � 0 �
12. Crop Type(s): _'3 Sl- W
13. Soil Type(s): L0 614c
14. Do the receiving crops differ from those designated in the CAWMP?'
❑ Yes
o . ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0-'No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3-1�o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
V No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[]Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[o ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Ins ection:
24'. Did the facility fail to calibrate waste application equipment as required by the permit?
•
❑ Yes
ONo NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[]-New
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[—]Yes
E�J-M
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus lass assessments (PLAT) certification?
❑ Yes
[3-1qo-
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E! j
❑ 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
L3-Ko'
❑ 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
[3'No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
[3 o
❑ NA ❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[If 'N.
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
13o
❑ NA ❑ NE
Comments: (referto question #): Explain any YES answers and/or any additional recommendations or say other comments::
Use drawings of ficility to better explain situations (use:additional pages as necessary).��:"
5 [Ud S ��-13 0 - 4r s �, qW,
li
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1
Date:
2/4 011

t ype of visit: U c:ompuance inspection W uperation Kevtew U structure Evaluation U i ecnnicai Assistance
Reason for Visit: (D-Moutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p7.' kSAr1 Departure Time: County: Region: Ff C
Farm Name_ M �� q 'FoRm Owner Email:
Owner Name: Mon mt— V\PAZS Phone:
Mailing Address: L2)Qg �A•r�cyR S l�R'L� e C't�,a,�EN.� 111C
Physical Address:
Facility Contact: on�� Mpg;} Title: (�anc Phone:
Onsite Representative: Integrator: Qer.013
Certified Operator: Certification Number: '�Qi$6a
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current Design Current Design Current
y at:
Swine Capacity Pop. V1'et Poult ....Capacity Pop. 'Cattle Cap 'ty Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer I I
T
Dairy Calf
Dairy Heifer
Feeder to Finish
WUO
Farrow to Wean
_ "D
- Desi Current
, Poult : Ca aci P.o
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
]Layers
Beef Stocker
Gilts
]Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Im
Other
Turkey Poults
Other
Other
Discharees and Stream impacts
1. Is any discharge observed from any part of Me operation?
Discharge originated at: ❑ SLruet`ure ❑ Application Field ❑ Other:
r,
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 5ErNo ❑NA ❑NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes [:)No
[:]Yes [O'No
❑ Yes E2r"No
g3INA ❑ NE
g*�4A ❑ NE
["NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: a -q I
jDate of Inspection:
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 fi2NA ❑ NE
Structure 1
Identifier: _ez
Spillway?:
Designed Freeboard (in)- /rj
Observed Freeboard (in): jo
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes &KNo ❑ NA ❑ NE
[:]Yes [;?/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 2"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
[:]Yes [trNo ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
hio
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
A
❑ 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): Cbt�p l �4 a,.�bQ� . ��(' Cz
13. Soil Type(s):`'`}�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B;rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rCrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[g<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[HfNo
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ENo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
&TNo
DNA ❑ 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
dNo
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
UErNA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: 9d, - Date of Ins ection: $
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CeNo ❑ 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 to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [ONo ❑ NA 0 NE
❑ Yes ❑ No C!(NA ❑ NE
❑ Yes [INo ❑ NA ❑ NE
❑ Yes 530No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes [yNo ❑ 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 Q No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [rYes ❑ No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
--
Use drawings:of facility to better: explain situations .(use additional pages as necessary).
C-�-`t �ie�z�a'�tK.3�SIi7L La�oo�A\`S 3n �1ni 'eVt11�T �. t`�C]M�.S•
2. ox {yCl_ W\..o M#\_ Fo fLV#.' O "— �5
��s��.,.sz.• `,o.d�C>`t� o � O� �h� o C�SCt � 4�o v� �: �s ���u 0... u v.�Ll T! c.�:� katL'i..
cd r-"
* Q. V09, P , ama_
'to
1l • �zSuw��# absER.�ta �st:.�l�s z p c►�s wQp�xa-��ac� R1Jc.c�os . Wa��o�
Rz�cr�as � Ra � TiCE .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ct►D-'> 'b -456,
Date: '1
21412011

r 3
I ype of visit: (7C:ompliance Inspection U Operation Review C1 Structure Evaluation L) Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: D Departure Time: County: Region: Ic
jl
Farm Name: Q MI TN' B2101 Owner Email:
Owner Name: Hoo roe NqN Ic Phone:
Mailing Address: 'i�QQQ -�PwAeA 0-lbi 2i
Physical Address: LL
Facility Contact: Oil f)O ►1 Title: D �n Phone:
Onsite Representative: i aHh l r Integrator: 2
Certified Operator: Ardl 'M MAL Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry `Capacity
Pop.
Cattle` Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish]—ja-
Q
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
IrD FPoiil " ' Ca achy
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Othe
urkey 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 C"No ❑ NA ❑ NE
[3 Yes ❑No ❑NA ❑NE
0 Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes t5 No
❑ Yes � No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Ins ection:
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): r
(�r
Observed Freeboard (in):�
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
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
15[ 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
N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. WYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding RHydraulic 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): C00J41 168-n146L �it��v e : SmaII Q�lll�l owl '_ wran t Ili ' S✓„v�l� I�u� 1 --
13. Soil Type(s): a I LOP, S F, i'djOPe..s 1 1. VO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�'No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application'?
❑ Yes
ffNo
❑ NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
[3No
❑ 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
❑ Was c Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
amfall ❑ 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
CRNA
❑ NE
Page 2 of 3
21412011 Continued

Facilit Number: - Date of Ins ection:
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 Cr;;;�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
NA
❑ 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?
❑ Yes
PSNo
❑ 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
C-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
Z: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
b'No
❑ NA
❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
§gNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
MNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additidnA recommendations or any other comments.,-" -
Use drawings of facility._to better explain. (use additional pages as necessary.)`
w roan
i R� ;mal w I 1 ma l �-oc� P.yr� co i
`t— a-. C cl,iet s�
l�
i n I f('6Z ( r i A G� � 1'n � � l i ns��-���
()n e s ho rt P vl l is o, (P7 acr + 6y t) ` v a bo,+
3 rS Q E_ yd r'1C overlQd_ of-aWt 33 36o l�osla,a�jn�a1B,
Slvdyc. Pa n Is a be 0- �{ �' �'Jo of S101_?.i e . hV 1 n er4 C)&')� a,W, ►-h
Cars
y
mi�,jonuj nVVV_ ��, n6s a� fred
Reviewerdnspector Name; Qt SG%j
Reviewer/Inspector Signature: 1 ,y, J r ax Q j,&
Page 3of3
Phone: 933 ,3 /
Date: Ava Q ji
t
/412011

�bij UC4- pet* f -t- -10 Noh(ve
*Facility No. Farm Name rl Date
Permit COC OIC_ NPDES (Rain breaker
PLAT Annual Cert )
Lagoon J
1
2
3
4
5
6
7
S illwa
Design freeboard
Observed freeboard in
Sludge Survey Date
y J
Sludge Depth ft
, 57f
Liquid Trt. Zone (ft)3
Ratio Sludge to Treatment Volume
Date
ActualCalibration
L�'1'-----�
—Design .
ul%�
. !
--�---
Actual -Width
EKR=�.
Soil Test Date 6 ��% Wettable Acres ✓ RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed 1Li Weekly Freeboard "" Mortality Records
Lime Applied —` 1 in Inspections t
Cu-1 � Zn-I� 120 min Insp. -71 Ilp 33� u� 3 orr
Needs P 0 Weather Codes
Crop Yield Transfer Shgets
- - - -
IMIRM.
MW"111l9
-' ..
ME"M.�M"1>QUMf+l
!�
. .
. .0.
tj )_ 0:) �"t
Verify P ONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
ibIoj
FRO or Farm Records
Lagoon #
Top Dike NIA4G�•�
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-1 3000= 213 lb/ac
App. Hardware

-37-7NS 2 -DS-- 2 4 / D
Type of Visit or-60—Mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: // ,30A7- County: �¢h-s rT a Region: F�
Farm Name: S'V% �r 1� Ma m'S f'"a" Owner Email:
Owner Name: �N�O 2 _ Ala'11-IS Phone:
Mailing Address:
Physical Address:
Facility Contact: �✓�'� Title: 7c�°�' Phone No:
Onsite Representative:
Integrator:
Certified Operator: ��'�'�� 114• /N6111S Operator Certification Number: AWi - zos6 Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = Longitude: 0 ° 0 I = "
Design Current
�DesignCjurrent
Design
Current
SRtine C*apacity Popetla6on
Wet Poultry Capacity Population
Cattle C+apacity
Populativn
❑ Wean to Finish I
T-❑
La er
❑ Dairy Cow
❑ Wean to Feeder I
I
Non -Layer
❑ Dairy Calf
eeder to Finish 72-0
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy_
El Beef Stocker
❑ Farrow to Finish
Gilts
❑ Non -Layers
❑ Beef Feeder
PE01 Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
L190
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[TITA--
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
BlqA-
❑ 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
[I Yes
No
-���
B <A
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
EJ-No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
GIT5
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: g2 — 9 Date of Inspection 5,-2
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 2 o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZO
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3< ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on -site which are not properly addressed and/or managed El2 Yes o ❑ 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 El o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes [ N ❑ 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 LSNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ..,//
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes E TK. ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O 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) ±�C ✓!4i(,t d r���'°i L� , � l� �j.-.._;✓ C .S. s6�h�rc�/ W�; .v ,�ivvzrc�CS
13. Soil type(s) �, �j 1AJ0_1
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
//
L�,,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
,D<oo
LET No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pilo'
❑ NA
❑ NE
tton4) p Eiphifi' nyY]
tg;.hetter explain situath
Reviewer/inspector Name �` v13 ' " ,^gin Phone: 91a . 5�33.33
Reviewer/inspector Signature: � Date: /—.Z, 8 — 10/0
12128104 Continued

v
Facility Number: Z— Date of Inspection yLa-!D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
B o
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EjlNo
❑ 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
N'�o
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,�
i <No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LE�,'N�o
❑ NA
[I NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L7 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?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes 2N�o
El Yes 3
El NA El NE
❑NA [I NE
❑ YesDfflN'
o
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
[3 o
❑ NA
❑ NE
❑ Yes
�❑ NA
❑ NE
12128104

32*,.-5 /0~07-Z60r-
vision of Water Quality
kacility Number g 9�0 O Diiision of Soil and Water Conservation
O Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
toutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: /� % �S` County: J4*"eS'0 Region: r n0
Farm Name: K Qh/ `S rM Owner Email:
Owner Name- Onr rc C- 104 _1W 1 s Phone:
Mailing Address:
Physical Address:
Facility Contact: — a t'riS Bar -w< c k „! Title: S�e_� Phone No:
Onsite Representative: Integrator: Co144
Certified Operator: ^ t M' MOt �" n s Operator Certification Number: /WA 2O A, Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e 0' ❑ « Longitude: 0 ° ❑ ' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
ff Feeder to Finish 137 Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischary,es & 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ED
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 B 1vo ❑ NA ❑ NE
❑ Yes ❑ No E35A ❑ NE
[:]Yes [:]No 91qAA ❑ NE
❑ Yes ❑ No (315A El NE
❑ Yes EM'o-- ❑ NA [INE
ElYes E15'o ❑ NA ❑ NE
12128104 Continued

I Facility Number: S2— 747 I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ETNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑'NO ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O'N'o- ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �❑ NA ❑ NE
maintenance or improvement?
Waste Application Erg. Are there any required buffers, setbacks, or compliance alternatives that need El Yes I_No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) tndrti (� i2 s�� t/%�+�n/ �O.S,� . S�1CJ�,�v�/6✓�;v/�.- .
13. Soil type(s) C f} �, ►vt W o e
'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Eoo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,13<0o
L� 'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
ElYes
3/
❑ NA
❑ NE
C da%f! ' %p In 1 JCL S �• ) f -J
see" G✓ � L'-�Lt� i-Ld�fC�Z�Jv
r!
La fae.&/ A& V" -A p Jf c f �Z 1 t/� .•s .11 �� � Q c s�acC w a r,�'.
Reviewer/Inspector Name yak e. _ l t/. / Phone: 910, C1.33.
Reviewer/Inspector Signature: Date: ?,/G -- Zoo `i
Page 2 of 3 12128104 Continued

Facility Number: S2 - ql. Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes G�qe' ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes B-5o ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other �,/
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes e No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ll ivo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�Q'Ko
ETNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
91 o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
BIG-
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R'Ko
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
alq-o
❑ 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'go
❑ 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
B-56
❑ 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
B- -o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9-11'6'
❑ NA
❑ NE
Additional Comments and/or
12128104

RrltlS y-O V - 0 8 R4e-
Type of Visit ercompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Q11outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: /: Departure Time: , Glp County: Region:
Farm Name: jV
Owner Email:
Owner Name: YD L AX -A 5 Phone:
Mailing Address:
Physical Address: 11��
Facility Contact: ✓>� 5 OR rw i CA— Title: 4 • .5 a Phone No:
Onsite Representative: riddl `5 Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= 0 0 t = is Longitude: = o = 6 = f{
"
Design Current. NPD;esig
ax'
n Chrren
Design Current
g[E]
e
ityPopulat�on Cattle
Capacity Population
❑ La er
❑ DairyCow
❑ Non -Layer
❑ DairyCalf
— -�
❑Dai Heifer
D
'❑D Cow
Poultry
+_ .._. airy
❑ Layers
❑Beef Stocker
❑ Non -Layers
Ti
❑ Beef Feeder
ty ❑ Pullets
❑ Beef Brood Co
Other
Turkeys
� '�
x ❑ Turkey Poults
h
❑ Other;
❑ Other
Number of Structures:
'
_
ean to Finish
ean to Feeder
eeder to Finish
']Z�
1�C
arrow to Wean
arrow to Feeder
arrow to Finishiltsoars
Discharges & Stream Im acts
1. is any discharge observed from any pan of the operation?
El Yes
��
L1 No
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
0 No
,�,/
(��,/NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
El No
L'7 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)
El Yes
❑ No
3"NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑Yes
o
El�NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
�[
ETNo
❑ NA
❑ NE
other than From a discharge?
Page I of 3
I2/28/04
Continued

Facility Number: f2 — '76
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:
❑ Yes ErNo
❑ Yes B No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ��
6. Are there structures on -site which are not properly addressed and/or managed El Yes L7 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
LJ
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 L] 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 LI No ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ETNo []NA ❑ NE
maintenance/improvement?
11.
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application` Outside of Area
12.
Crop type(s)
13.
Soil type(s) I-01—
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
LT No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
9<o
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
9<o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Rfo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
10
❑ NA ❑ NE
Reviewer/Inspector Name ��� G t/ G l� Phone: 9�V S/33.3330
Reviewer/Inspector Signature: Date: $ //— Z160
Page 2 of 3 12128104 Continued

FacilityNumber: — 716 Date of Inspection
Required Records & Documents �,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes [J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El"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
El"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 El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
NNo
[I NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
,EJ
E3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
a -No
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes R<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B o
❑ 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
E3No
❑ 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
Q<o
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,__,,,��
32, Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[I NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,L1"No
1 11Vo
❑ NA ❑ NE
Additional"Comments ancUor Drawings: gob
s
Ak
Page 3 of 3 12128104

fD Division of Water Quality
=acifityumber SZ 0 Division of Soil and Water Conservation
- - 0 Other Agency
Type of Visit ® Compliance inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint O Follow up 0 Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Q» Arrival Time: 1119.,3 Departure Time: �Q County: n/ Region:
Farm Name: K�R94�GJi`S G���-mot Owner Email:
Owner Name: 121OA/ VO -e /ITa55Lri S Phnnp:
Mailing Address:
Physical Address:
Facility Contact: 13a V W i Title: 'V• 44 k Phone No:.
OnsiteRepresentative: a aL ''e-k Integrator: t�O�tcrre.. t
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
��
Latitude: = 0 4 Longitude: =° 0 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
137 2 0
2/9
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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?
Design Current`
Cattle Capacity Pop li tion
❑ Dairy Cow
❑ Dairy Calf
❑ Mahry Heifer
❑ Ply Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ER No
❑ Yes
® No
❑ NA
❑ NE
El Yes
[4No
El NA
[I NE
12128104 Continued

Facility Number: z — g(p Date of Inspection O-ON
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5No ❑ 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): —3011
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CO 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
Wo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
%No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drifi ❑ Application Outside
of Area
12. Crop types)Sf[ „ �L+�[4 C�9t�t'si �/
C 0 r 5.
-- —
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
0 Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
5ONo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E4 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):
Spvar.� 2.Ob�
A
Sf►'-�cl.+e
o k,*- -
.! ow kv%�
e!� f Gv��t�
2uv7 .� �,.L 1.sn
IS
Zold : iffo 5J11-J
UUs?
p fArS
Cl- 5 d tC 0PIt-n
do b - �
, V, t-Gu
)Ct
i*V
a-lC O/� 7-4 6 7- ZOs
Reviewer/Inspector Name
�,y
Phone: q/Q . 4W . 33 o o
Reviewer/Inspector Signature:
Date: /o -- p /— Zo07
12128104 Continued

Facility Number: �Z — (, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes [� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 05 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
16 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
[WNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
IVNo
❑ 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
® 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? [I Yes M No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
q No
❑ NA
❑ NE
and report the monality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
V9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

_ _ _,
0 Dn�ston.�of Water Quality° '
Facility Number $ Z Q Ifivikiontof SoiP a Conser��a_tion
,� Q Other Agen
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: �-03—OLa Arrival Time: /0,'SS Departure Time: County: S� _L Region: _F_K-Q
Farm Name: A&Jeng._ A S l,�,a/r��a_ Owner Email:
Owner Name: I'Koivyo e- 7 Phone:
Mailing Address:
Physical Address:
Facilitv Contact:
Title:
Phone No:
Onsite Representative: _M06,0 C /y%1S Integrator: Ca4ar- --
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gifts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = 4 Longitude: 0 ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La cr
❑ Non -La et
Dry Poultry
❑ Lavers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design. Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-DaiEy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
!Number of Structures: EJ
b. Did the discharge reach waters of the State'? (If yes. notify DWQ)
c. What is the estimated volume that reached Nvaters 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 ® No ❑ NA ❑ NE
❑ Yes
1A No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
JR No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
12128104 Continued

Facility Number: $2 — °f (a Date of Inspection n3 O!v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IS 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): / c]
„
Observed Freeboard (in): 2 Z
5. Are there any immediate threats to the integrity of any of the structures observed? MYes M 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 R 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 El 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z 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) (3tvM�ldc� �a�. +�erwy,��.� grsr�tei
�i+1�1/ crr�tly(„�Ovey See
,
13. Soil type(s) C R L 0.
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
(A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
191 No
❑ NA
❑ NE
`toaueshon
"7, 5-11 +rcz��. 1,,,t LgSa.r,+ nrc,;.,d- *6 6.:"_ rz....0V-
4r'�e r.a5" s i-cVt4 i s �1�51, j �. 51. r-a;w► c�v.l� �.ar..a.- pruj6 ",s. Plt•Je.
T4(4 cc k a. 4a I.*lCr FvaL�pyy LWt / /� 7
d [ .N d:.NCt �.Jl� ��l�'rVr.ci L,/..:�`C. //GN.
Reviewer/Inspector Name " I &
Reviewer/Inspector Signature: 1qtA R� Date: 5-03 - Z 0 0
12128104 Continued

Facility Number: SZ. — 1?& Date of Inspection 5-03-a
Required Records & Documents
I9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ 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
E9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Dd 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
IN 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
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4�1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional?Camnients."' dfor Dra ngs v '°
12128104

0.2 R. 9<:�
Type of Visit e 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: 1a: Ica Departure Time: County: 5Ckry%pjou Region: k` k �
Farm Name: %n n n t fa zz M tL fl , fa. •ri Owner Email:
Owner Name: h?nr, c 3 Phone: ^ `1'/° 5947 -- 6 Y.-I -C-
Mailing Address: So U_.✓.b�. S� ll10 14, _ Cf, rn +cw' I`cL JB�a�
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: /77on..a /-Y7 4 fA 3.4 Integrator: C, A A 4,
cz-
Certified Operator: /770r/ o c /7? a A;_j „ _ Operator Certification Number: 07D86-17 _
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
�o �d 0« g ❑o=, Q
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er �#
I ❑ Non -Layer _
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
77.?�
3 G ¢
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other '
Dry Poultry
❑ Layers
ElNon-La ers
El Pullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
ElDai Cow
El Dairy Calf
El Dairy Heifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Col
I
Humber of Structures: 17J.
.
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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[--]No
❑ NA
❑ NE
[INA
❑NE
❑Yes
❑No
V] Yes
❑ No
❑ NA
❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
12128104 Continued

Facility Number: > a -- G Date of Inspection 35/ os
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): —At_" IV, 2a 4 14 1 `
Observed Freeboard (in): 0,2 "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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/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 l0 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) gel_r"L<e%. Aa%, /,3��..,��� Ar es S►-•,. �1_a1
a:-. O�
-
13. Soil type(s) e4 4 , L '-" , zo /Q
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
[M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes
[14No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No ❑ NA ❑ NE
0, G h c r G sio 0 f' ''1 Gd 1- I 1 r
�J "kv j�% . • f GCS �_ CL._4 ej k. 1-0 It,- d rp V C- +-h 4 J
a- l4 r0c.c^-'e- r- l't, i1 +-p � tc- 10 1 are. I"" k kd- 16,E �- w 4j Co;.+4;.��2�
t%/ie, .cr- o-C- -�to4 v-�- roetca csk 1�•, fiy a►-u-.a4- tvc-ltc.
Reviewer/Inspector Name �L a _y L �� Phone: 5/D VA
Reviewer/inspector Signature: ,. Date: 3 // Z V�
12128104 Continued

'Facility Number: Date of Inspection 3 N oF-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [N Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ER 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
1� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[!9 No
❑. NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
(NNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Y 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? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerAnspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
qi onaIN mments and/or- Drawl A '
r.
a! - Cc� r c� K¢ t i r. 4 S a L. �JC ! ►,. �i r O J t. �C Q l< s i- 1 1 O Lht' —
d, S c ., 1 T,:, c0 t„ k oLj `) i v\ t l', l a I if3 td dL
1Mls�� be- re-Y"ovto2 csv.A (11r0perkL p(LtDaj<A- 04P,
Sb41 pH i-c
A '--at �t a v C •-� l! w
i�nr. �ar��� ;� L►a,,;�,� +ING
Y" 0 kl A w o.
fl r 0 n 0
12128104

IType of Visit OTompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Qlioutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Bate of Visit:Mg�g Tune:
9'
O Not rational O Below Threshold
Eermitted Mertif�ied 0 Conditionally/Certified 13 Registered Date Last Operated or Above Threshold: -.. .
Farm Name: .......... '! 6n.%............................ t' iA`W�iS......... �Qrw►........_ County: .... +:..:............_.._.... .._......... .
Owner Name:........ ... r!.!gOlrr.... ..`..... .A__A4I *5l...._..---- .......... Phone No: .. �.L!z.40CT 19�..... _...... _..... ........
Mailing Address: � ........ u!?i�l!'t...._St!davl^..� .... _ ._ lr41+V
Facility Contact: r `6M .r w__... ^14 '� -Title: Phone No:
Onsite Representative: 1'Tr
�...W wiL Integt-ator•.
Certified Operator: ,�.!� �. S ..... ........ Operator Certification Number-
. ..._... _.._�.�....._._.a.__._....
Location of Farm:
99wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0a 04 0" Longitude 0 ` "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EiWo
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 gal/min?
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 G11qo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [gio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes - 52,Ko
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �................. --—-------- ........ .._.... ................
Freeboard (inches):
12/l2103 _ — Continued

1Facility 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type�bwul OvU.Se-ej
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
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.
l
Cmvul Lw
446J :+ts�
c•s
405.
❑ Yes GWo
❑ Yes RNo
❑ Yes UK
❑ Yes BONO
❑ Yes B"No
❑ Yes ff No
❑ Yes E!rNo
❑ Yes BORO
❑ Yes ff$lo
❑ Yes QNo
❑ Yes B N' o
❑ Yes [(No
❑ Yes E '�lo
❑ Yes ETN'o
❑ Yes [�No
❑ Yes [Rlo
❑ Yes 13<o
.opy ` ❑ Final Notes
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: v
12112103 / 1 Continued

Facility Number: — Date of Inspection i} o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [9 o
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 [2fio
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Gwo
[Kaste Application Dyfreeboard Q-Waste Analysis [,Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ErNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
20&o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
2No
28. Does facility require a follow-up visit by same agency?
❑ Yes
QNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
BNO
\rPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[Kes
❑,, NNo�o
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
Gallo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [a'No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [R�lo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 12d Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention: - v -
Facility No. -
l
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: C) , 1995
Time:
Farm Name/Owner: M .YN.
Mailing Address: (� + • L-1 - (Sox 3 -I I -A
County: 00--kin - _
Integrator:_ �� - - - Phone: ! n 5 5 a — 6 `I -Z.5
On Site Representative: tic, r�w ' c� ^ Phone:
Physical Address/Location:
Type of Operation: Swine ✓ PouItry _ Cattle
Design Capacity: ; nc-rej Number of Animals on Site: sk %'n +
DEM Certification Number: ACE DEM Certification Number: AC
Latitude: Longitude: ° "
Circle Yes or No
Does the Animal Waste Lagoon h
(approximately I Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: C to .
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
Oor No Actual Freeboard: 9 Ft. 5 Inches
oon(s)? Yes or S Was any erosion observed? Yes or&
e3s or No IS the cover crop adequate? es or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es or No
100 Feet from Wells? ffa or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l&o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or
Is animal waste discharged into water ofAe state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 6�or No
Additional Comments:
Inspe/' "&"_ C"� ,
ctor Nam
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 9-9 , 1995 ---�
Time:
Farm IS
Mailing
County
Integral
On Site Representative: &.�'*c doe dutch Phone:
Physical Address/Location: 10
Type of Operation: Swine fr Poultry Cattle
Design Capacity: 21 1 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' " Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour
(approximately 1 Foot + 7 inches) Yes or No Ac ual Freeboard:�rFt. _T— Inches
Was any seepage observed from the la n(s)? Yes or Was any erosion observed? Yes or
Is adequate land available for spray.
e or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (Ye0or No
storm event
No
100 Feet from Wells? Wo?'No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(&)
Is animal waste discharged into water ofke state by man-made ditch, flushing system, or other
similar man-made devices? Yes orW If Yes, Please Explain.
Does the facility maintain adequate waste management recor s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Uor No
Additional Comments:
Inspector WAine
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

REGI ST�.ATION FORM. FCC ANIM-A-L FEEDLOT OPERATIONS
Department of Environment, health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds t`at are served by
a liquid waste system, -then this form must be filled out and mailed
by December 31, 1993 pursuant t^ i=A NCAC 2L .0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: M. 61a +k S
Mailing Address:,R
Sal —
County 5, , Phone Na
Owner(s) Name: -
Manager (s) Name:. -,/VA-
Lessee Name: IVA
:arm Location (Be as specific as possible: road names, direction,
milepost, etc.): 4_ �z� if ; l�.s T-, ;, �f C4,4,, e4 ^ --Irr -
Latitude/Lcngi:.ude if known:
Design capacity of animal waste management system (Number and type
c, confined anima (s) ) � / C.Z `1' .n•t�n4 {'7 r-%, i
Average animal population on the farm (Number and type of animal (s)
raised) 3 -2 0
Year Production Began: /ff ASCS Tract No.: 673
Type of Waste Management System Used: ?gym.
Acres Available for Land Application of Waste: 3Ll
Owner (s) Signature (s)DATE
I DAT
u

Jlte Kequtres lmmeaime Auenuon
Facility Number: 3- %
SITE VISITATION RECORD
DATE: , 1995 ,{ `--
Owner: Tn.�.se_,�, -_ Farm Name:
County:
Agent Visiting Ite:__-�,�,m. d� ._..� Phone:
-- �, --
Operator: , _ — Phone:
On Site Representative: Phone:
Physical Address: a� CQ
Mailing Address: _ P-T 4 � - 1 6 CD;;� 11)c _ cw3w
a
Type of Operation: Swine Poultry Cattle
Design Capacity: 3-73D -_ Number of Animals on Site:
Latitude: 3 y c 5 _==0 Longitude: -� S U f S
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Laaoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes o No Actual Freeboard: �_ Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes No as there erosion of the dam?. es r No
Is adequate land available for land applicatio 'e or No Is the cover crop adequate1�Y or No
Additional Comments:
.L,Lt REO- OFFICE . , 7-
Fax to (919) 7I5-3559 Ej Signature of Agent

�1

CA E
�OHARIE
C E N Al M.K. MATTHIS