820100_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
II

�iype of visit: w uomptrance inspection v Operation KeVlew V,ti•ucture EVamanon v Iecnnical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 31 l Arrival Time: Departure Time: jZ' Q County: Region: -gyp
Farm Name: #wet C�AL C Pa, 0, Owner Email:
Owner Name: 7_�o rO4-S &`Jhetil � Phone:
Mailing Address:
Physical Address:
Facility Contact: J6_ r%a f ' ett^ M, l fe,r^ Title: Phone:
Onsite Representative: 4 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Des' Current
Capacity Pop.
Wet Positry
Layer
Design
Capacity
Current
Pop.
Design Curren#
Cattle Capacity Pop.
Dairy Cow
NA
❑ NE
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
D . P,oultr
"' ""
Design
Ca aci
Current
Pio
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
-
Pullets
Turk e s
Turkey Poults
Other
Beef Brood Cow
Other. f -
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �j No ❑ NA 0 NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes ❑ No
[:]Yes [J� No
❑ Yes 0 No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page l of 3 2/4/2015 Continued

[Facilidumber: - / 0 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 19 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No W 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 P 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® No [:]NA ❑ NE
waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 Anofication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] YesNo ❑ NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [SLNo ❑ 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 ❑rEvidence of Wind Drift ❑/� Application Outside of Approved Area
12. Crop Type(s): 41 a SSi 4c, . ?a �� , (* . a4",
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? ❑ Yes 9SO No ❑ NA E:]NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes � No ❑ NA [:]NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes iNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T ansfers ❑ 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 P-9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili ,Number: - Date of ins ectiow 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 M No ❑ NA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes 0 No ❑ NA ' ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
J] 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
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist. at the facility? If yes, check the appropriate box below.
❑ Yes
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
I'MNo
❑ NA ❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
P No
❑-NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: Q- q33 _ 36V
Date: -7hl-j&
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! r Arrival Time:_. Departure Time:, r County: S/Q'N'����� Region:
Farm Name:�S' S.yrka Owner Email:
Owner Name: ltin of 6�d,4-5 Phone:
Mailing Address:
Physical Address:
FacilityContact: _�for4a4,Zj,
u
Onsite Representative:
Certified Operator: yA®fuas tfi wjef f
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: 7:D M p� -
Certification Number: f 7O
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
airy Cow
® No
Wean to Feeder
airy Calf
- Feeder to Finish
D. P.oul
Ga aci
P,o
airy Heifer
Dr
y Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Lavers
Beef Stocker
Beef Feeder
Gilts
Boars
Other 4
Non -La ers
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other Other
Discharses and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes W No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
® No
® NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

FacWty Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[-]Yes
[RNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Spillway?:
No
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in):k
❑ Yes
No
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(i -e., large trees, severe erosion, seepage, etc.)
17. Does the facility lack adequate acreage for land application?
T
No
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesNo F]NA ❑ NE
waste management or closure plan? 10
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ❑ YesNo ❑ NA [:]NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evionce of Wind Drift El Application Outside of Approved Area
12. Crop Type(s): %'Q.., k
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
13. Soil Type(s): o.4
F�] No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0!?No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
F�] No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield D 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
r?�No
[DNA ❑ NE
Page 2 of 3
214/2015 Continued

Tscifi dumber: 0 p Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes rO 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
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes 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 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 No ❑ NA ❑ NE
Comments (refer to question # . Explain any YES answers and/or any ad'ditioual recommendations ar any other comments.
Use drawings ofifacility to better explain situations (use additional pages as necessa_ry).
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: r]
Page 3 of 3 2/4/2015

Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:;41 Arrival Time: Departure Time: s.1 County:
Farm Name: '— �h s Lt,: Owner Email:
Owner Name: S to S' Phone:
Mailing Address:
Physical Address:
Facility Contact:
d h 1 V k 111149,, Title:
Phone:
Region: Fila
—
Onsite Representative: N Integrator:
Certified Operator: 5 �F Gi�d�, L� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
--
�1
Swinty
Wean to Finish
_,
UlDen�k'Cnrre `t�� ��. Design CurrentDesign Current
Popa Wet�Poultry Capacrty --Pop _ Cattle Capacity Pop.
Layer Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
b
Dr foul
Layers
Design Current
@a aci 1'0
Dai Heifer
Farrow to Wean
Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Turkeys
TurkeyPoults
Other
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 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 W ff No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
EDNA ❑ NE
® NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/412011 Continued

Facili Number: -1 Ob jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
rI
Observed Freeboard (in): 3 7
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V] 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 P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 10 No ❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? ❑ Yes EpNo ❑ 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 P No [:]NA [—]NE
maintenance or improvement? TT
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cro Windo�jw� ❑Evidence of Win ft Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 1 }No
❑ Yes 7�`"` No
❑ Yes No
❑ Yes ONo
❑ Yes V No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes r�)No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5`iN
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes R No
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Qa Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N No ❑ NA ❑ NE
25. Is the -facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S 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 10 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 F^No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. 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 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 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?
gy es No ❑ NA ❑ NE
Comments (refer to:queshon #) Explain anyYES answers andlor any additional recommendatior any, other romments��-
Usedrawings of faciity_ta better ezplain situations (use additional Rases as necessary):u
=
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �10- y; 3. 3 3oa
Date: tob-I //!(a
242015

type of v tsu: W t_:ompttance inspection V uperation meview V structure r,valuation U I ecnmcal ASS15tanCe
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: '—� Arrival Time: Z.iAp Departure Time: a ! County:s4T"elbri
Farm Name: (3"Ade" Sw A' Owner Email:
Owner Name: —rL,,� AL,, p G".,5 Phone:
Mailing Address:
Physical Address:
Region: FR D
Facility Contact: Z6P ateTitle: Phone:
Onsite Representative: t Integrator: r` ,
Certified Operator:
Operator:
Location of Farm:
Latitude:
Certification Number: I `�
Certification Number:
Longitude:
Design Current
Design
t:nrrent
Design Cwrent
Swine Eapacity Pop:
Wet Poultry
Capacity
.Pop.
@tittle Capacihy Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non-I.a er
Dairy Calf
Feeder to Finish
- -
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,oal
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
F-FB—oars
I 113eef Brood Cow
1 3:111
Turkeys
(?they
Turkey Poults
Other
Other
Dischar es and Stream Impact
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 P No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
❑ Yes ❑ No [a NA ❑ NE
[:]Yes ❑No
❑ Yes No
❑ Yes ® No
®NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

Facility Number: jDate of Inspection: Fj
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
Identifier:
Spillway?:
Designed Freeboard (in):
r�i~
Observed Freeboard (in): /
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., Iarge trees, severe erosion, seepage, etc.)
IF No ❑ NA ❑ NE
E] No �NA E] NE
Structure 6
❑ Yes 01 No [:]NA [:]NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T1- 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YJ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V] 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
lDrift
- ❑ Application Outside of Approved Area
12. Crop Type(s): Q41��S
❑ 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 [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �p No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued
13. Soil Type(s): /a, LjQ'
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?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1r No
`�
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking[] Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �p No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

R Facili Number: Date-of Inspection: (p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes [P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesNo ❑ NA [—]NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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 Ep No ❑ NA ❑ NE
❑ Yes [�] No ❑ NA ❑ NE
❑ Yes 0] No ❑ NA ❑ NE
❑ Yes No
[-]Yes No
[:]Yes ® No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer toCquestion #): Explain any YES answers -and/or -any additional recommendations or any otfier comments Y
Use drawings of faci*io better explain sitnations'(use°additional pages as necessary).
Reviewer/Inspector Name: �92 6LI4 I'y a4Ue Phone: `j10 -Y33-3300
Reviewer/Inspector Signature: !�' ► �' lQ Date: �h
Page 3 of 3 214/2014

I ype oR visa: t4ruom wiance inspection U vperatnon Keview U Structure Evaluation U 1 ecnnlcal Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
i'JAL ill
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: �� �L4i'g_ f �1Le Owner Email:
Owner Name:�n'C � � t� K''`i.. � 5f. L' j.�S Phone:
Mailing Address:
Physical Address:
Re�
Facility Contact: Title: _ Phone:
Onsite Representative: 'L'� Integrator: k%t D
Certified Operator: _ L( � (� Certification Number: G ` �,J
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
_. s- _ ,.
Desi n Current i• •
Design Current � Design Current
Swine
Capacgity Pop Wet jWU1. - " Capacity Pop.
.;.
Cattle Capacity Pop.
_
Wean to Finish
Layer N,Dairy
Cow
Wean to FeederNon-La
er
Dairy Calf
Feeder to Finish
-EE]
t
Dairy Heifer
Farrow to Wean°*r
` w mac. •
* ,.-xkr,�, Design Current x
Da Cow
Farrow to Feeder
D Poul k P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
urkey 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?
❑ Yes a<o ❑ NA ❑ NE
❑ Yes [—]No IBJ 5A , ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[—]Yes ❑ NoNA
❑ NE
Z. Is there evidence of a past discharge from any part of the operation?
❑ Yes-�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes �' o
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facili Number: - Date of Inspection: rt
E3'<o
❑ NA
❑ NE
❑ Yes
Waste Collection & Treatment
❑ NA
%
❑ Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
[,. ''
❑ NAAONE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q -NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats totheintegrity of any of the structures observed?
❑ Yes
[allo
❑ 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
C3'1: 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Ej T o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
G o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0_1�o
❑ NA
❑ NE
v
maintenance or improvement.
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes To ❑ NA ❑ NE
D 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): �f a
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? '
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
E3'<o
❑ NA
❑ NE
❑ Yes
E),
❑ NA
❑ NE
❑ Yes
2 -Co❑
NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
[:]Yes
a_K�o
❑ NA
❑ NE
❑ Yes [ <o ❑ NA ❑ NE
❑ Yes 0-90 ❑ NA ❑ NE
❑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 D 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 X[:] 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 2/4/2011 Continued

Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ir)rNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
F
mments (refer to question-#): Explain any YES answers and/or any additional recommendations or any other comments -e drawings of facility to better explain situations (use additional pages as necessary).
❑ Yes U No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yesto F]NA ❑ NE
c,(bv4v, S- 7-(y
e
Reviewer/Inspector Name:
-t —�q 4( 0— 3, �'2
saA
p - qt �\ g,
LI 00v\ 1-0 e
Reviewer/Inspector Signature: Date:
Page 3 of 3
Facili Number:Date of Inspection:
• 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ef5on ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
D -No— ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
V No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
PA -o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ir)rNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
F
mments (refer to question-#): Explain any YES answers and/or any additional recommendations or any other comments -e drawings of facility to better explain situations (use additional pages as necessary).
❑ Yes U No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yesto F]NA ❑ NE
c,(bv4v, S- 7-(y
e
Reviewer/Inspector Name:
-t —�q 4( 0— 3, �'2
saA
p - qt �\ g,
LI 00v\ 1-0 e
Reviewer/Inspector Signature: Date:
Page 3 of 3

19 c --I <1,
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: O 4
e
Farm Name: ( re�Lc -S(y 6ty— Owner Email:
Owner Name: 1 �10 bK .L r ll-�� G �[f Phone:
Mailing Address:
Physical Address:
Facility Contact:
LTitle:
r�
Onsite Representative:
Certified Operator: ��N+ut f GJ_&(0'(
Back-up Operator:
Location of Farm:
Latitude:
Region -F&L
Phone:
Integrator: IM
— R
Certification Number:
Certification Number:
Longitude:
�
Des t
CPo en
4' Design
Design Current
Swine Ca acg�
P 'ty p.
M In
;Current
Wet P �
onitry Cap c ty op.
Cattle Capacity Pop.
..
�z
Wean to Finish
Layer
Da' Cow
Wean to Feeder
H
Non -Layer
Da' Calf
Feeder to Finishs4 so i YQn
.Da
Heifer
Farrow to Wean
�
DesxgnCurrent
D Cow
Farrow to Feeder
*
l ,.;, Ce aei
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
ers
Beef Feeder
Boars
7RD
Beef Broad Cow
_KIMMher
"* ,r
oults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made? ❑ Yes E]r<o A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
MNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
g] -<o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6X30
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214/2011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
❑ Yes
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
ffNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
❑ Yes
Q,?'o
1:1NA
❑ NE
Spillway?:
❑ Yes
L.:kKo
❑ NA
❑ NE
Designed Freeboard (in):
Observed Freeboard (in):�e
❑ Yes
51to
❑ NA
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[p<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
D<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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
<No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
05K
❑ 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
LLd40
❑ NA
❑ NE
maintenance or improvement?
Waste ARylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E4Ifo ❑ NA FINE
❑ 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): rjrrll��
13. Soil Type(s):
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?
[] Yes9:?00
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q,?'o
1:1NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L.:kKo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
51to
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L_a4lo
❑ 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 [;K. . ❑ 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 '11Sludge 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 F]T<o , ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

Facifi Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [—]No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No
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 ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ 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 ❑ No ❑ NA ❑ NE
Lbetter any additional commendations or as other commentsUe drawm sof facility to elam situations (use additional pages necessary).
y -
-S(
j r- 5 ``
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
F] NA F] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:0fZ.
0-
Date: 5 P
21412011

/ic-)/'-)
►U
Type of Visit: aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: (Y Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L a Arrival Time:O�»i,jtaJ'� Departure Time:lt7'', County:g�A�lpSart
Farm Name: G—xzQI` rG & t_; "y4Q Owner Email:
Owner Name: "TV,,b"S MT K� Gs 0X)p iv_5 Phone:
Mailing Address:
Region: L^ b
Physical Address:
Facility Contact: OSoc%tP,\hA0 rn=LJE2 Title: Phone:
Onsite Representative: toxmt Integrator: _ � u R�1r�V "'� RnLUa
�r
�
Certified Operator: T►hcrrnA _5 G3-00L*\5 Certification Number: "j 3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
gnCurrent
©esiMir
Capacity Pop.
Wet Poultry -..:Capacity
La er _
Design
Cnrrent
Pop.
Design C►urrent
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
31AW
Dr. P.©ult ,
Layers
Non -La ers
Design
Ca acity
Current
F,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Turke s
ITurkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 E No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
[]-14A ❑ NE
[fNA ❑ 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 gNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facili Number: a -10 a Date of Inspection: S 5
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
[2"'NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1pk
Observed Freeboard (in): zo�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
62'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
[Z 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
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[✓! No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[✓]rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
CE(No
[DNA
❑ 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): Q�tRvto► Kw Qt %S Qm_ 1 % -G. t,
13. Soil Type(s):�p��.�'t� + �AQ,Ll�Y'`1 it1Ac
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [TNo [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes ❑'No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [+"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [►� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[R'NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: 'a.. - ko Date of Inspection: [S f
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:)Yes [EfNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [yNo ❑ 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 eNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No ❑ NA IEJ ' E
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 ZNo ❑ NA ❑ NE
[:]Yes ff No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes [j?"No ❑ NA ❑ NE
❑ Yes [�No
❑ Yes D%
❑ Yes ff No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other cornments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tflS Phone: Qlo�3a$-IaT,3l
Date: .S I Is 11 'X
2/4/2011

IW2 /,D//Z) /i
vision of Water Quality
Facility Number L. w i - I AIK� I Division of Sail and Water Conservation
QQ Other Agency
Type of Visit:C..,,ompliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
GRo
Reason for Visit: `utine 0 Complaint Q Follow-up 0 Referral Q Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: lCounty Region:
Farm Name: Ap Owner Email:
Owner Name: S Phone:
Mailing Address:
Physical Address:
Facility Contact: Uti,� j �� Title: Phone:
Onsite Representative: Integrator: M-19
Certified Operator: _ �� �,(�Qi.e,�s Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
oe
1. Is any discharge observed from any part of the operation? ❑ Yes If No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No R2016 ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
0 Yes
❑ No
�}A
:Design estCurrent Design Current
IJIWet
c. What is the estimated volume that reached waters of the State (gallons)?
Mne
y Capacttr Pop. Cattle Capacity Pop.
.... a-.
[-]Yes
❑ No
Wean to Finish La er Dai Cow
Wean to Feeder Layer Dai Calf
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
01 o
Feeder to Finish - Dai Heifer
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Farrow to Wean g. „; Dest ti Current Da Cow
to
. R
Farrow to Feeder D . -: Poult „ ;�;�s':„Ca $ $oP. Non -Dai
❑ NE
of the State other than from a discharge?
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
-
Other Turkey Poults
Other Other
Discharges and Stream Impacts
oe
1. Is any discharge observed from any part of the operation? ❑ Yes If No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No R2016 ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
0 Yes
❑ No
�}A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[-]Yes
❑ No
12 A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
01 o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
to
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

lFacility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Imo"' ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No l__ v'A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
[dentificr:
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
io
Spillway?:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
52Ko
Designed Freeboard (in):
the appropriate box.
Observed Freeboard (in):
❑WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements
❑Other:
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes tD""
❑ NA
❑ NE
waste management or closure plan?
a54
❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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 Qi 'lo
❑ NA
❑ NE
8. Do any of the structures lack adequate markets as required by the permit?
❑ Yes [2o<
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �o
E] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [L2'wo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 42TNo
❑ 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): 64L 42�,'_� 5,4�
13. Soil Type(s): 12 �2 - &L
14. Do the receiving crops differ from those Lsignated in th CAWMP?
❑ Yes UkKo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [?<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes M401,
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2—eo
❑ NA
❑ NE
Required 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? If yes, check
[] Yes
52Ko
❑ 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
21<o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
a54
❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
A ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes g;'110 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�F<oo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes
ga-lVo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[E>E"'
❑ Yes
o
❑ NA
❑ NE
❑ Yes fl:Jo o ❑ NA ❑ NE
❑ Yes MJko ❑ NA ❑ NE
❑ Yes [g—llo [DNA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes [t�fo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes 0? o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes l .Kb" ❑ NA ❑ NE
Comments refer to question # : Explain any YES answers and/or any additional recommendations;or any -ether commeafs -i k` '
Use drawings�of,facility to better explain situations (use additional pages as necessa )..
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone: WV ' 'Si -f S —_
Date: Q 6
4MI1

8zNs 6/21/zOIO
- ivision of Water Quality
=acifltymber 8 2 /00 O Division of Sailand Water Conservation
Q Other Agency
Type of Visitcom��pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 840"0 -tine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '/7-/Q Arrival Time: Departure Time: County: S Region: 05L7O
Farm Name: r'CyldQrw/ �5 SWi, 2 Owner Email:
Owner Name: —7—Ont 4;ddeAl Phone:
Mailing Address:
Physical Address:
.//Coe
+o c/1�v Title: ru� f S
Phone No:Facility Contact: K
Onsite Representative: J nNA"�ff N M; I Cal/ Integrator:
Certified Operator: IOa* �r d�U►/S Operator Certification Number:
Sack -up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=;
='. Longitude: = o = c =
Design CurrentM
Design Current
Design Current
❑ NE
❑ Yes
Sinc Capacity Population
Capacity Population
C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
[3<A
❑ Wean to Feeder
❑Non -La er
ElDa' Calf
❑ Yes
® Feeder to Finish O
❑ NA
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
PGilts
Boars
❑ Pullets
❑Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any pari of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L7No ❑ NA ❑ NE
❑ Yes
❑ No
3'5A_
❑ NE
❑ Yes
❑ No
9<A
❑ NE
[3<A
❑ NE
❑ Yes
❑ No
❑ Yes
G o-
❑ NA
❑ NE
❑ Yes
ff5o
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

Facility Number: —fib
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes E//No El NA El NE
El Yes Z<0 ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?.-
pillway?:Designed
DesignedFreeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?NA
❑Yes
No ❑
EINE
(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 thr t, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ErNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ff No ❑ NA ❑ NE
❑ Yes L7No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ 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
£arHlIa /er
��12_ Crop type(s) {J *w — W �X
13. Soil type(s) g A -B
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA ❑ NE
El"No ❑ NA ❑ NE
Io ❑ NA ❑ NE
No ❑ NA ❑ NE
aNoNA ElNE
0 EII NA ❑ NE
Reviewer/InspectorName �f*@�Q� S Phone: 9�D• 533- 33Dfl
ReviewerlInspector Signature: Date:
Page 2 of 3 12/28/04 Continued

a_ r
Facility Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design 1­1Maps ❑ Other
❑ Yes No ❑ NA ❑ NE
❑ Yes G<o ❑ NA EINE
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
ElL+�? Yes
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather
Code
❑ NE
If yes, contact a regional Air Quality representative immediately
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
2<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
33. Does facility require a follow-up visit by same agency?
El NA
E] NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,__ �Ngo
2<
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[INA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El2 Yes
,<o
o
❑ NA
❑ NE
Other Issues .
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes GI 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?
ElL+�? Yes
o
❑ 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
El Yes
�,�
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?
ElYes
o
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 11/28104

Iiym-S 11 -10-2 0 9
WA
Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: %/ /e.7 - D Arrival Time: Departure Time: County: 2&Af _ n/ Region:
Farm Name: �/ d d>r"� S-St��itJ e— Owner Email:
Owner Name: -70--"tf Phone:
Mailing Address:
Physical Address:
Facility Contact:,`G/�u�e� Title: -tel • SLS' Phone No:
Onsite Representative: �/Q.1Ti azu A Ile—i✓ Integrator:
Certified Operator: �� �9�o�dc�S Operator Certification Number: 7�3�
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E o❑ I E u Longitude: 0 0 [� g❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
DesignCurrent Design Current Design Current
Swine Capacity Population Wet Poultry Gapacit Population Cattle Capacity Papulation
❑ NE
❑ Wean to Finish
IEJ Layer
I Cow
❑ NE
❑ Wean to Feeder
❑ Non -Layer
❑Dairy Calf
❑ NE
Feeder to Finish 3b501 3
El Farrow to Wean
❑ Farrow to Feeder
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
ElLa❑
❑ La ers
❑ Beef Stocker
❑Non -La ers
❑ Beef Feeder
❑ Yes
Farrow to Finish
❑ Gilts
❑ NE
❑ Pullets
❑ Beef Brood Cowi
❑Turkeys
❑ Turkey Poults
❑ Other Number of Strucheres:
❑ Boars
Other
ElOther
❑ NA
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
B<A
❑ NE
❑ Yes
❑ No
L'J' A
❑ NE
LANA
❑ NE
❑ Yes
❑ No
❑ Yes
[INA
❑ NE
El Yes
�[�'�lo
L�<
❑ NA
❑ NE
12/.28/04 Continued

Facility Number: S2—Date of Inspection
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes B o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L-f"No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L Q i
Spillway?:
Designed Freeboard (in): % Qr
Observed Freeboard (in):%
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PTo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
[I2 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?
[I Yes
2Koo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R 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
[:INA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0<'
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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 El Evidence of Wind Drill ❑ Application Outside of
Area r
12. Croptype(s) 0t-'W"du.. e#6,r/ �ING�� ►'�,�, CO3.5,J. Crpt/-WNeAl—YdZZeaitl
13. Soil type(s) (3c g _Lj4.B AtzLe,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,[RTo [INA El NE
I
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Rllo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ,B- o El NA [3 NE
17. Does the facility lack adequate acreage for land application? E] Yes ,Ea41*5� ❑ NA [:1 NE
I8. Is there a lack of properly operating waste application equipment? ElLYes 1< ❑ NA ❑ NE
��,+-fir :?�+�u
Comments (refer to.question'0Explain any YES answers and/or ani recommendahons or any other comments
Use drawings of facility to better explgin,situations. (use additional pages as a ess ry)
Reviewer/Inspector Namet V t,�s _ :,- I Phone: 9/0, X33.
Reviewer/Inspector Signature: Date:
12128/04 Continued

Facility Number: 8,2 —Jap Date of Inspection
AL
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ONo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L'f"1Vo
El NA
El NE
the appropriate box.
❑ WUP El Checklists El Design [I maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
�
BK.
❑ 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
�❑
Ek<o
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes��o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
o
El NA
[__1 NE
26.
Did the facility fail to have an actively certified operator in charge?
C1 yes
,2
2<
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D<o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,��,,��
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
�L,fN�o
[3 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?
El Yes
�,
2<0
❑ 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
ElYes
911101
❑ 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
[3'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
911 ❑ NA
❑ NE
AddttionatCommentsan/orDraings x'aqn
AL
12/28/04

Srii(S -7 - 2i - 0 8
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit erf outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7-/7' D 8 rArrival Time: �; SO Departure Time: 2 3� ,.L County: S l>So� Region: FP_
Farm Name: _ TG ; dd e_r► 5 sw" rj <-- Owner Email:
Owner Name: 1Th o oka_5 M Kms- G+ Geer S Phone:
Mailing Address:
Physical Address:
G eAM K e.. +v ccl i e u:• . 5('e_:- .
Facility Contact: T. a,% -t Ao.,u AA �i t;� Title: Phone No: (M-10 \
Onsite Representative: G e_" D K GN N e -C1 h D Integrator: r �, �� C M' $ J
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
❑ 1 =" Longitude: =0=6
o=6 ❑ ..
Swine
❑ Wean to Finish
Design Current
Capactt} Population
Wet Poultry
❑ La er
Resign Current
Capacity Puopulation
Design Current
Cattle Cap��ty Population
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Yes
❑ No
[gNA
❑ Dairy Heifer
❑ Farrow to Wean
❑ Yes
Dry Pul
otry
�1A
❑ D Cow
❑ Farrow to Feeder"
ElNon-Dairy
El Farrow to Finish
❑ Yes
El Layers
[a'�NA
El Beef Stocker
Gilts
[I Yes
❑Non -La Non -Layers
[INA
❑ Beef Feeder
P Boars
El2 Yes
❑ Pullets
❑ NA
❑ Beef Brood Co
other than from a discharge?
...:.
❑ Turkeys
Other
12/28/04
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[gNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�1A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[a'�NA
El NE
2. Is there evidence of a past discharge from any part of the operation`?
[I Yes
[--�<o
[INA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El2 Yes
o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: 82 Date of Inspection
[INA
[:1 NE
13<0
[INA
Waste Collection & Treatment
No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�"
E] ivo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): *3
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
D 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
2<o
❑ 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
�
2 o
❑ NA
❑ NE
maintenance or improvement?
Waste Agulication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ETNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ifo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El 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) geY use. �� �c.stu�c :9~tl 6rr�i.0 .s% CoI-N- Wr.1�
13. Soil type(s) Icr nt 4-- N M a, C
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
t 6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
DIN
[INA
[:1 NE
13<0
[INA
0 N
No
❑ NA
❑ NE
No
❑ NA
❑ NE
[ No
❑ NA
❑ NE
Reviewer/inspector Name C RQUP-15 :� Phone: 9IQ, `f33 •333n
Reviewer/inspector Signature: Im Date:
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection 7 -17 -
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP [I Checklists El Design El Maps El Other
❑ Yes No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EfNo
[JNA
[I NI?
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L"J Nc
NA
[INE
❑ NE
If yes, contact a regional Air Quality representative immediately
-E]
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
ETNo
NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
—El
EYNo
❑ NA
[INE
[ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ETNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
�L`� No
[:INA
❑ 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
�
El 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
[I Yes
�/
2 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
❑ NA
❑ NE
Additional`Gomments and/or Drawings '";f �1a?,� 44A+���� xa F ';a
AL
Page 3 of 3 12/28104

3Imf lab -h-) ; vj
rl. Division of Water Quality
Facility Number gL p Q O Division of Soil and Water Conservation
Q Other Agency
Type of Visit W 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: O Arrival Time: Departure Time: rr County. Regionx P-0
Farm Name: CSI �k!Q.1S rn l� Owner Email:
Owner Name�lCiS 1! 1_E tt� t� 5 Phone:
Mailing Address:
Physical Address:
�
Facility Contact: �(�yz is K2:AK\ 1�[ _ Title cTe� Phone No:
Onsite Representative: ' j y Integrator: P fft'Yl
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
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o =' ❑ Longitude: =0=' ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
��—I r,T=e ❑ Non -La et
Dry Poultry
Non -L
Pullets
Ulurkey 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?
Cattle
Design Current.
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoNg
Number of Structures 71
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes k No ❑ NA ❑ NE
❑ Yes
❑ No
�] NA
❑ NE
❑ Yes
❑ No
W'JsiA
❑ NE
---��
[A NA
❑ NE
❑ Yes
❑ No
❑ Yes
[5No
❑ NA
❑ NE
❑ Yes
❑ No
NNA
❑ NE
12/28/04 Continued

Facility IgIumber: — Date of Inspection L
❑ Yes
P. No
Waste Collection & Treatment
❑ NE
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes
rNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
PNo
❑ NA
Spillway?:
19. Is there a lack of properly operating waste application equipment?
❑ Yes
Designed Freeboard (in): LI RS
❑ NA
❑ NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
XNo ❑ 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?
AYes
❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
[❑ Yes
[X No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[A No ❑ NA ❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�*o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) ri, m v_op ti i r . Z5Vn Q�xr 01S
13. Soil type(s)
0
14. Do the receiving crops differ from those designga ed in the CAWMP?
❑ Yes
P. No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
Pg�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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):
Reviewer/Inspector name CH ej U) N 2" N7 iN Phone:q to `t C�
ReviewerAnspector Signature: Date: (I)FIC 1
12/28/04 Continued

Facility Number: Z„— 1 (0 Date of Inspection Tb 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �ANo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes �&No ❑ NA ❑ NE
the appropirate box_ ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A+No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P:No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CRJNA
❑ 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
PLhio
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;UNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�(No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�Vo
[INA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ANo
❑ NA
❑ NE
33_ Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Comments and/or Drawings:
,Art to n k • LCL Ir Gjc>L...l �u-2DtJy
a
�°� s4ar,c�.
RSl C.C� m rn�,►ti.r� a 5 0 , � Ste. �tP �-1-f..n �xJ� 4.�►.� [C.Jx.a�T
v
12/28/04

facility No. Ott Time In.1 � L�f Time Out Date
Farm Name �_o_Rir-, � "t— — Integrator t' fCtl S -W _
Owner 71I1pry"Q0.5 "Vic ca -,46 A's Site Rep -
Operator No.
Back-up No.
COC Circle: eneral or NPDES
Desi n Current Design Current
Wean -- Feed Farrow - Feed
Farrow - Finish
Feed- Gilts 1 Boars
Farrow - Wean I Others
FREEBOARD: Design / Observed G
Sludge Survey Calibration/GPM O 4 1
Crop Yield Waste Transfers
Rain Gauge Rain Breaker S
Soil Test Wettable Acres t'�_ PLAT
Weekly Freeboard �� Daily Rainfall v 1 -in Inspections f
CJ
Spray/Freeboard Drop OM_:q _V w- ti -1 U�
tj
Weather Codes 120 min Inspections
Waste Analysis: d�
Date Nitrogen (N) Date Nitrogen (N)
[ [ z . %
S �
Pull/Field Soil Crop Pan Window
c�
LQ v
-

Division pf Water Quality
11=Facifflymber $ Z - COQ 0 Division of Soil and Water Conservation
Q Other Agency
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: Arrival Time: 3:10 Departure Time: :UO County: Sd sdn/ Region:
Farm Name: SW I!AJ I Owner Email:
Owner Name: _ �/i► f-- a..r 1 TO A,& rg I �A P.✓ S' Phone:
Mailing Address:
Physical Address: r
Facility Contact: G7 eao Ke.4JiutTitle: -CL Phone No:
Onsite Representative: Integrator: TI Lwi/r�a-� Std. �•��
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ O ❑ I = u Longitude: =0 E--] , =I u
Swine
❑ Wean to Finish
Design Current Design
Poult
Capacity Population Wet ry Capacity
Current Design Current
Popularion Cattle Capacity Po pulation
❑ Dairy Cow
❑Wean to Feeder
Non -Layer
❑ Dairy Calf
Feeder to Finish
��
El Heifer
Farrow to Wean
❑ Farrow to Feeder
r�
��r�•' ul
a Dry�l�o�try
El D Cow
El
EJ Non -Dairy
❑ Farrow to Finish
❑ Layers
ElBeef Stocker
El Gilts
Elon ers N -La
El Beef Feeder
El Boars
��. ❑ Pullets
10 Beef Brood Cowl
" El Turkeys
Other
❑ Other
❑ Turkey Poults
IEJ Other
Number of Structures:
Discharges &Stream Impacts
I, Is any discharge observed from any part of the operation? ❑Yes [NNa ❑ NA ❑ NE
Discharge originated at: ❑Structure El Application Field []Other
a. Was the conveyance man-made? El Yes [INo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑yes ®No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes 19 No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation'? ❑Yes [9 No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes 7
❑ La er
Discharges &Stream Impacts
I, Is any discharge observed from any part of the operation? ❑Yes [NNa ❑ NA ❑ NE
Discharge originated at: ❑Structure El Application Field []Other
a. Was the conveyance man-made? El Yes [INo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑yes ®No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes 19 No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation'? ❑Yes [9 No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes 7
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Fadlity Number: gZ— %OC} Date of Inspection
AL
Waste Collection & Treatment
Reviewer/Inspector Signature: Date -
ate:
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[)rNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 50 I,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1`7 No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
tCj 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
[4 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)
4. Does any pari of the waste management system other than the waste structures require
❑ Yes
[X -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ yes
5nNo
❑ NA
CINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,Gv ar'r C_ ['sR
13. Soil type(s)
i
14. Do the receiving crops differ from those designated in the CAWMP? ElYes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
14No El NA [I NE
ro No [:1 NA [INE
[2TNo ❑ NA ❑ NE
No ❑ NA ❑ NE
-comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments."
:Use drawings'of facility to better explain situations. (use additional pages as necessary): � ,,;rte
Page 2
AL
ReviewerlInspector Namee ✓2[S Phone 9/a� yj3-33o a
Reviewer/Inspector Signature: Date -
ate:
Pagel of -3 12/28/04 Continued

Facility Number: TZ, - p Date of Inspection F -67-07L7970-4
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 appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [$No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EffNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
7No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[,M No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1;4 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
[y 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
T 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
[;X No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12/28/04

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint () Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: G - Owner Email:
Owner Name: M•'ke r5•� T,,,q 6:.' 1, �- f Phone: `1/0- S`i
Mailing Address: �/G 8v /?,g ,na ._L_U nom. � Ne. ,� (rr�z Al
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: 6 (.6A/11•' / Integrator: P.o.--3:a,+, ! �6.
Cr,w(
Certified Operator: _ _ 7�.+ :,, ��c -.s Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: p =1 Longitude: =0=6 o❑6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Uf eeder to Finish (, p 1370-0-1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
i
Dry Poultry
❑ Layers
❑ Non -La vers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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 hleifei
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker i
❑ Beef Feeder I
❑ Beef Brood Cow
k
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 U<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
21�o
❑ NA
❑ NE
❑ Yes
U<o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment ,�_,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1_3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?❑Yes ❑ No ❑ NA [:1NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: P7 o
Designed Freeboard (in): ,2 y '*'
Observed Freeboard (in): -; 1/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L" No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes B<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 0 -Ko ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑<
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El[_�
Yes
,—,
'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
�--,,�
D' o
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ElD Yes
o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAccenble Crop Window El Evidence of Wind Drift El Application Outside of Area
If-
,� G.p 1,-)- 3u�> 9'3
12. Crop type(s) 86-1mr1 A 4<Llvr�L-� -SonQ 4 ct rc� iso.; rnv�u /�/�s.� . ,. _ U. '.,xr/'
/00
13. Soil types)
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? ❑ Yes
0-1q'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
❑ No
❑ NA
M -NI;
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
'K_E
18. Is there a lack of properly operating waste application equipment? ❑ Yes
(-io
❑ NA
❑ NE
��Sg.�ri( �rr�Soa�c( ••5
.)i1,' Rev4,eld ILA -1 w,lh Mr, l,-/'/'; IS,
Reviewer/InspectorName Mur. [ �, u0. 1 Phone: Cto
Reviewer/tnspector Signature: %i' • Date: .-2
12/28/04 Continued

Facility Number: $a VO Date of Inspection 7 +3s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9-vO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Bio ❑ NA ❑ NE
the appropirate box. ❑ Wblf'� ❑ C:h d is ❑ gm ❑ miffs ❑ Quer
21. Does record keeping need improvement? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE
L''J Waste Application ❑ ❑ Wmte-AMdiysis ❑ So4-ATrafysis ❑ Wemc�ers ❑ Annual Certification
❑ ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ s ❑ Wea+n-C=ade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes B No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EI No
❑ NA
❑ NE
24.
�ivn lr�l
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EKo
[:INA'
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EKo
ElNA
[:1NE
26.
Did the facility fail to have an actively certified operator in charge?
ElP Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EKo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B<o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ<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
ElLam
,--�
- o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
[:1 Yes
,�,
L�'lvo
❑ 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
Ko
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[:1P Yes
o
❑ NA
❑ NE
;aldditiooaloComments.and/or Drawings y s ;, .'� �, .; I"
d
#.1 Pi�4• ' s7 u, mss.'.9 fie Sf,'R. -for,
�5 cf�l;
12/28/04

Type of Visit GrCompWce Inspection O Operation Review O Lagoon Evaluation
Reason for Visit C),Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
17 Facility Number !]D Date of Visit: D / Time: I 1 . D 71
Q Not Operational O Below Threshold
© Permitted 0 Certified © Conditionally Certified Q Registered Date Last Operated or Above Threshold -
Farm Name: ..... 4t R aG�nS ..'! #^�, .. ------------ ------ County:
Owner Name: P1 . ItOT (r �dri► _. _. �__.......� ..... Phone No: s..
ilaiilingAddress: -_ 4- ��rt I'tt1 .W w. _._._!+tP�►`�U►1 YS� �?_
Facility Contact:�..._._.. „ ._._. Title:.. .---•--. - Phone No:
_ ._
Onsite Representative• p Integrator:
Certified Operator:........ l dew' _._ ............._ Operator Certification Number:.-,----
----- -.......... ........._...w...___.......
Location of )Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` ` " Longitude • 1 "
Discharges - Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑.Ko
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ o'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 0-90'
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 GKo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [;PAo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches):
12112103
Structure 1 Structure 2 Structure
Structure 4 Structure 5
❑ Yes U440
Structure 6
.......
3 5.---............ ...................... ...--... _.................... ....... ----.....................
-- .._.�._. _......_ __..........-.�...._..__...._...
Continued

t Facility Number: bpd Date of Inspection
�d r�c��� s 9 sod c
�i
`
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
❑ Yes
P<
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
��
7. Do any of the structures need maintenance/improvement?
❑ Yes
E3 No
8. Does any part of the waste management system other than waste structures require maintenanctfimprovement?
❑ Yes
Leo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
L710
elevation markings?
Waste Application
I0. Are there any buffers that need maintenancerimprovement?
❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
leo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �Grw• j 5F N i 'SFr r 4w u 4( -(
13. Do the receiving crops differ with se designated in the rtified Animal Waste Management Plan (CAWMP)?
❑ Yes
EW0_
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Bq4`o_
b) Does the facility need a wettable acre determination?
❑ Yes
two
c) This facility is pended for a wettable acre determination?
❑ Yes
QVo"_'
15. Does the receiving crop need improvement?
❑ Yes
D446
I6. Is there a lack of adequate waste application equipment?
❑ Yes
D -No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Erigo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �Lo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes LtiQo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ISO
Air Quality representative immediately.
tog -
Cots (referIIeshoa #) F�[plarn any YES aaswers amd/gr any or any, r comments.
�-
Use drawyngs poi fatty to better explaen s[tuahoits. (neettpsial pales as necessary) field Co Final Notes
s F r_ pY ❑ t
_
�d r�c��� s 9 sod c
�i
`
/ai ;e" -N i K 4'-c 71 �L�LT�Ol1
7
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 03
12/12103 y /� Continued

Facility Number: p — /00 Date of Inspection / o
RRe uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
120 Minute Inspections ❑ Annual Certification Form
❑ Yes , 0
❑ Yes a
❑ Yes Plzo
❑ Yes B o
❑ Yes ❑<o
❑ Yes
.W'�
ElL Yes
,❑_
410
❑ Yes
BW_O
❑Yes
CIAO
L7 r es
❑ No
❑ Yes
l 61 -Ko'
❑ Yes
M,<oo
❑ Yes
®<
❑ Yes
QfiTo
❑ Yes
9-90—
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Add tuonal Commtnts and/or Drawiags _-_
_
12/12/03

j
Site Requires Immediate Attend n:
Facility No.2� o v�
DIVISION OF ENV M0NMENTAL MANAGfiMEN7
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 r _,1995
Time: LL' a
Farm Name/Owner: ❑ M 196 T h b MO S G S AkO s
Mailing Address: L 2bQ P+OS-%" W i " R a +(1,W Von Grow? , nL a 93Ub
County: Summon
Integrator:
Phone: 0(10-.55SI gel 19
On Site Representative: LJ2.16 NiP-1 _ Phone: � 17
Physical Address/Location: S. A 1917
Type of Operation: Swint F►n. poultry rattle
Design Capacity: 346-0 F;a, Number of Animals on Site: fra
DEM (;q rti&cation Number: ACE DEM Certification Number. ACNEW_
Latitude -IS—* _LL' Longimdew�_' _2D_'ALS "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches Xe or No Actual Freeboard: ---2_.,, Ft. U Incites
Was any seepage observed from the M;No s)?
Is adequate land available for spray?
Crop(s) being utilized: -k–' _
Yes or(R Was any erosion obed? No
Yes o
Is the cover crop adequate? es or No
Does the facility micet SCS miaununi setback criteria? 200 Feet from Dwellings) Yep or No
100 Feet from Wells 1, Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o Na
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes C(F)If Yes, Please Explain.
Does. the facility maintain adequate waste management records (vols of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: _ XQC) 7 bp,-
LA
Cfk,E-c"'Lt
,S at -c-1
l
`ti,tv�ctc.i
Inspector Name
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.

f
A r,_I WLST3 2L1NAr. 2iT PLAN CZRi ==KATION PSR IMA OR =ANDEL rE=MCTS
please return the completed fo= to the Division of ffivi:ormantal Naaagement at
the add --ass on the reverse side of this fo=.
Name of farm (P1 ase print):
Address, 9b --A—J
Phone No.(
County: Sa,o��),
Farm location: Latitude and Longitude:�S=lo`�pz/Zg`_-�- �' (required) . Also,
please attach a copy of a county road map with location ident' ied.
Type of operation (swine, layer, dairy, etc.)-
Design capacity (number of animals):
Average size of operation'(12 month population avg.):
Average acreage needed for land application of waste (acres)1 2 Z-4
a3aaaaaax�aaaaaaaaasaayaassaaayaaaasaassasaasaaagraaaaaa:aaaassaas3aasaasa�s=has
Tec2m=ical Specialist Carzifiaatioa
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to 15A NCAC 67 .0005, 1 certify that the new or
expanded animal waste management system as installed for the farm named above
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
avzro=ental management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Water Consecration Commission pursuant to 15A NCAC 2H.0217 and
15A NCLC 6= .0001-.0005. The following elements and their corresponding minimum
c=ite;ia-hate-been verified by me or other designated technical specialists and
are included in the plan as applicable: =inimum separations (buffers) ; liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party); access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the controlof the discharge
of pollutants from stormwater runoff events less severe than the 25 -year, 24-hour
storm_
Name of =ec'..xaical Spocialiat (Please print)
Affiliation: S
Address (Agency) : O Phone No. —
Signature • ^^ _ Date
acsssasaaaaaasyaasaaaaassssaasasa=s:assaaaaaaasaass:aasasaaasaaaasasasrs
OwnerIW--ager Agresmaat
I (we) understand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will implement
these procedures. I (we) know that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the Division of
Environmental "Management before the new animals are stocked. I (we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25 -year, 24 -dour storm_ The
approved plan will be filed at the farm and at the office of the local Soil and
water Conservation District.
NA=a of Land Owner (Please Print) /
Signature: Date:_,.- - 4- -
Ns.:.e of ifaaaQer, if different from owner (Please print):
Signature: Date:_
uatg: A change in land -ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer.
DEM USE ONLY: ACVr:w#
ie &Ce 407 ean,-,