820101_INSPECTIONS_20171231

NOH I H CAROLINA
Department of Environmental Qual

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 0 Denied Access
Date of Visit: 7 3 / Arrival Time: Departure Time: jc County: Region:
Farm Name: gbsk Owner Email:
T '
Owner Name: �4� cSwi1� iu�.S LLC Phone:
Mailing Address:
Physical Address:
Facility Contact: JL_Aluo ^, Alla-1 Title: Phone:
Onsite Representative:9*s�t: k Integrator: 5 'k -CW
Certified Operator: 6 I? [B Sc Certification Number: A-731
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
lip
Design Currents
❑ NA
Design
Current
Design Ci117 ent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to FeederNon-La
er
Dai Calf
Feeder to Finish-
,
:. � _ „ ,.i. -...,.I
Dairy Heifer
Farrow to Wean
Design
Curret .
Dry Cow
Farrow to Feeder
I) . P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
M.
Turkeys
Other
_ _
Turkey Poults
Other
MOther
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 MINo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
MNA ❑ NE
®NA ❑NE
[�NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: 2 jDate of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I_
® No ❑ NA ❑ NE
7❑� No Q NA ❑ NE
Structure 6
Spillway"?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 0
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ YesISI No ❑ NA ❑ NE
waste management or closure plan? to
If any of questions 4fi 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 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, andlor wet stacks) IF
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [$M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window jj ❑ Evidence of Wind Drift 11 ❑ Application Outside of Approved Area
12. Crap Type(s): Ce4S4al SS Q l d PS+$ -e,1
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?
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
W No
No
No
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 111 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 2/4/2015 Continued

Facility dumber: Date of Inspection: jj 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. Pi
❑ 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
r7-3 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
[DNA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
0 NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
0 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
s of.._necessary).yh .
Comments (refer to gTye,tobetter_e' lain situationsuse additional as
p
stioai#)io�Ein any:YES:answers and/or anyadditionalrecommendations or any other commen
lase drawin facilits
Reviewer/Inspector Name: _9la,-✓f' M" i,- Phone: 1M9: '_r1_L kC1
Reviewer/Inspector Signature: Wj _04a _ Date: 3
Page 3 of 3 2/4/2015

z ypr ui v zsrt. V x-ompuance inspecuon z i vperanon icevzew V atrucrure r vamauon v it ecnnicaj-Lssistance
Reason for Visit: O Routine O Complaint O Follow-uO Referral Q Emergency O Other O Denied Access
Date of Visit: I c// -7//Y! I Arrival Time: /p; Departure Time: County: Sa+K Region:
Farm Name: ADre-5W 11-4-
Owner Name: 50-C !'".SR_
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: V%. /�`•� Title: Phone:
Onsite Representative: Integrator: —7-D M
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
❑ No
❑ Yes
Design
Current
Design CurrentSwine
Capacity
Pltry
4—B!z7a
Capacity
Pop.
CatHe Capacity PoWean
to Finish
Dai Cowry
Wean to Feeder
Dai CalfFeeder
to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , Poul
Ca aci
Pio
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
1
Turkey Poults
Other 7
Other
.: �.�3L
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 T
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes
❑ No
❑ Yes
No
❑ Yes
No
®NA E] NE
T9 NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili • Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No kN NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2..
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3y
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 O No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) IR
9. Does any part of the waste management system other than the waste structures require ❑ Yes FN No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes P 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 ❑ Evide a of Wind Drift ,,❑ Application Outside of�Approved
/Area
12. Crop Type(s): 45rfJd,( a ct-v_ J� � � 0`'�'�-�-d1
13. Soil Type(s): 1114 j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1�i No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ED Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:!Po ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F.acili Number:p Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm . ❑ Yes Q9 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo
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 P No
❑ Yes � No
❑ Yes P No
❑ Yes (�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
C] NA ❑NE
❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes P No E] NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 6D No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [P No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes PjNo ❑ NA ❑ NE
Comments,(refer to. .:quesda;4.)": Explain.any YES answers and/or any additional recommendations or any other,comments_
t.3Y
lise drawmszs-of. facility #o .better: exnlatn situations fuse additional napes as necessarvl. E
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
F�4
JZL
Phone:
Date:
2/4/'2015

it
119
Type of Visit: ® Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 4D Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:Arrival Time: P Departure Time: County: , Region: �L j
Farm Name: ILOS2 5i'L Owner Email:
Owner Name: � i2O5--P Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Integrator:
Phone:
M
❑ Yes V
Certification Number:
Certification Number:
Latitude: Longitude:
4' Design ,Current
igDese Current
...
..-
Des Current
ign
�gn
No
CC ac ty
Pop. W,et�Poultry a�acityCattle
Capacity Pop.
� No
La er
Da' Caw
Non -La er
Da Calf
' " "
Da Heifer
Design Current
D Cow
Dr. Poul Ca acit Po
Non-Da'try
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean "
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream IIDUactS
I . Is any discharge observed from any part of the operation?
Discharge originated at: E) Structure ❑Application Field Other:
a.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than fr
om a discharge?
No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[:]Yes
❑No NA ❑ NE
❑ Yes ❑ No ®NA ❑ NE
❑ Yes E]
Page 1 of 3 2/4/2011 Continued
No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facility Number: 17 jDate of Ins ection:
IF
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 l Structure 2 Structure 3
Identifier:^
Spillway?:
Structure 4 Structure 5
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
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
1PNo
❑ NE
F]NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ Yes
No
❑ Yes]
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
1PNo
C—]NA
F]NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
M No
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
[] YesNo
❑ NA
❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.❑Yes No ❑ NA [:]NE
❑ Excessive Ponding El Hydraulic Overload ❑ Frozen Ground [D Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable C op Window ❑ Evidencp,6rWind Drift ❑ pplicatian ide of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M 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
[] YesNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo
ElWaste Application E]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Tra sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2No
❑NA C] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ONE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
0 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 EpNo ❑ 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 ® No ❑ NA [3 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? ❑ YesNo [:]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 ❑ YesNo E]NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) 1P
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?
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?
en_ts{refer to quest
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
wary Yr:, answers anaror any aaatnor
:n .situations (use additional pages as no
❑ Yes IM
No
❑ Yes TNo
❑ Yes No
ons or any other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:`T to -r q7 -e3306
Date: raT(,7
21412015

Ii ype of visit: ! c.omptiance inspection V vperanon iteview V Ntructure Evaivanon u t ecnnicai Assistance
Reason for Visit: *Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: Connty:1*9��Ar^J Region: !`&
Farm Name: r� �, I�pSQ _ Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: jva� jL(,� Title: Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
❑ No
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
CattleCapacity
Pop.
to Finish
La er
Da Cow
UWean
Wean to Feeder
Non -La er
I
a' Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , P,o
Ca aci
�o
Non -Dairy
Farrow to Finish
JLayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
JPullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
.. .
Other
Discha 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 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 No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
[:]Yes
❑ No
❑ Yes]
No
❑ Yes
© No
NA ❑ NE
np NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

Facili Number: C> Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '37'4 3 Ld
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No jP NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
t
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
JP No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4.6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste A olication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
Tj
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, [—]Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window //'' ❑ Evidence of Wind Drif ❑(Application Outside of Approved Area
12. Crop Type(s): Cang'( fes" ()-rgt�S 6k,,)VU, "T``t., ©�,we,,
13. Soil Type(s): d9Y rMeJ-1 O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of property operating waste application equipment?
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
14. 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 CA WMP 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 q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

11'acili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo E]NA [:]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check E]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 T No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [)a No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EPA 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 p Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
g No
❑ NA
❑ NE
Commentsrefer to question
lUsedrawing'sV facility to better explain situations {use;add ndlor any additional recommendations or any other comments:��
ftExplain' lain YES an answers .
additional pages as necessary).`.."_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t
Phone: g/d_�,W 33cO
Date: to/�/-'r
214%1014

U1
ly 1.
of Visit: C¢<om ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Gr outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: c County: Regi[`
Farm Name: 1W �— Owner Email:
Owner Name: Z ©o t) . [LO Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: 1' 1, jz
Certification Number:
Certification Number: til 74-5
Longitude:
Design Current
Swine Capacity -Pop.
Wean to Finish
Design.Cyrirent
Wet Poultry-= - CapacityF P4
La er
Design Current
Cattle apacity Pop.
C
Dai Cow
Wean to Feeder
I iNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
{
Design Current
Dr.. Poul ' Ga aci Pop.
Layers
Non -Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
K''
Other
Turkeys
Turkey Poults
Other
Other
h11�'YL2:-'i-J'�.uFhi,�:.'i4'+YY�
�Ome'.r.-_—....i.yEti•,::::,l:p: ,-
Dischar,2es 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 ❑ No❑ NE
i
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 ❑ o NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? E]Yes Vo ❑ 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 2/4/2011 Continued

.r' DO 1 11404.
Facility Number: - Date of Inspection:
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No NA NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(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 [f 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
E No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
El"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes
[a<o
❑ NA
❑ NE
9. Does any part of the waste management system other than the waste structures require
[:]Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
❑Other:
Waste Application
❑ Yes
[v]'No
❑ NA
[] NE
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
@31ro~
❑ NA
❑ NE
maintenance or improvement?
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[`fNo
❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes alzo ❑ 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 WindowQ ❑ Evidence of Wind Drift E] Application Outside of Approved Area
12. Crop Type(s): a Zvvk 'K_ ( '5 & 0
13. Soil Type(s): NO V--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
u loo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[a<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2<0
❑ NA
❑ NE
acres determination?
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[v]'No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
; "o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes❑
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
E2<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
[`fNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
2�No
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: jDate of Inspection:
❑ Yes
No
❑ NA
;4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Cj.N6'_n NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
NA
❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Z<o
List structure(s) and date of first survey indicating non-compliance:
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
E No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L_Tl"u ❑ NA
❑ NE
Other Issues
❑ Yes
E?� o
❑ NA
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E3,<o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
❑ NE
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
Q'Na
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Z<o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ca�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E?� o
❑ 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 additional recommendations or any other comments
h f_
Use drawings of facility to better explain situations (use additional pages as necessary). a
a(CIL, t VN;.+t k_*1­, , S -f,7 -� 4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tk
Date
2/4/207

Type of Visit: t$;70utine
iance ]inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:tArrival Time: Departure Time: County: -� Region
Farm Name: t �� Owner Email:
Owner Name: eS Phone:
Mailing Address:
Physical Address:
Facility Contact: 4' alk I Title: f Phone:
Onsite Representative: integrator: h4-13
Certified Operator: ��'� tz Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design.
Wet Poultry Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
iry Cow
Wean to Feeder
Non -La er
[] Yes
Io
iry Calf
❑ NE
El Feeder to Finish
iry Heifer
Farrow to Wean
❑ Yes
Design
Current
Cow
Farrow to Feeder
D , ,Point .
Ca aci
P,a
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
❑ No
NA
Beef Feeder
Boars
❑Yes
f No
❑ NA
I 113eef Brood Cow
Turkeys
Other —Turkey
Poults
VN o
❑ NA
❑ NE
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
Io
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
[ <A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
G:J.NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
f No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VN o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facifi Number: 006,Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P<9 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes [No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes &�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 O:Ko ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes njNo ❑ 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
[Vo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�-�,�
L_LJ'�"o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ 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): 6 enc" 5-G 0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA MP?
❑ Yes
Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EA'N'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
l No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FB4o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[(
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�i<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ 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 2/412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0/-o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [;4Xo [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Bio ❑ 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
rNo ❑ 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
Ck o ❑ 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
io ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o [:3NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
0�'<S ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ YesNo
❑ NA
❑ NE
Comments (refer to question #: Explain `any YES answers andlor any additional. recommendations or any other comments= w
Use drawings of facility to better explain situations (use additional pages as necessary).
m�
Reviewer/Inspector Name: 6 t
Reviewer/Inspector Signature: }.l i
Page 3 of 3
Phonel'O
qa_3_9_3L_
Date:
Z/ /20II

Kr
Type of Visit: ©Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance i
Reason for Visit: Q*<outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: Arrival Time: Departure Time: is Ar*► County: T Region:
Farm Name: 1A OS4 � k -1T t*t V-VkgmS_ Owner Email:
Owner Name:— 2&,,_ Q, R Q g e- Phone:
Mailing Address:
Physical Address:
Facility Contact: pn j> �� pn�1iU L{Z Title: Phone:
Onsite Representative: Integrator:
Certified Operator: /O p t_ R ws e Certification Number:'
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current .1
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I ILayer
airy Cow
Wean to Feeder
Non -La er
I
ai Calf
Feeder to Finish jlultb 154
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca act
Po P.
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
[:]Yes E No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes EvrNo
❑ Yes [yNo
EfNA ❑ NE
[5NA ❑ NE
[RNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued
I

Facitity Number: Date of Inspection: j
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [yNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EJ'NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i02 � ��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3"Ro A ❑ 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 E!I<o ;rA ❑ 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 [jjll�o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [;JI�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 [5,1�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [j'10 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U3 N' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): IJP h
13. Soil Type(s): %ZQz l�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [yNo 0 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Cq�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [g'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes []R"'No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes GrNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[D,f4o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[DAo
❑ 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
194
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA ❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: - y Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D"No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D40
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
E] NA E] NE
❑ NA Q'<E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2'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
[Eivo
❑ 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
[ 1 o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
G 'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[g -No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[To
❑ NA
❑ NE
ents (refer to quesfion #�: Fapiain any YE5 answers andlor any additional recommendations or any other comments.awings of facility to better explain situations (use additional pages as -necessary).
F
�i1wc�t, sv%v Qys �oc.L 1 ixs os a E a ARZ, W" " J'3 uE Uf\VSl_ aoiLk
N_A5F_ 9aaA'2£.ss bp+IZL pp -E-14,5 i:NQ0U1\6 b04, 1_fksocrvg c �
Reviewer/Inspector blame:
Reviewer/Inspector Signature:
Page 3 of 3
Z�ti
Phone: �i10 30-1 1
Date: pj1i5` �a
2/412011

_1311n5 1VzU i_1 _off
ivLOO—i-sion of Water Quality
Facility Number � - O Division of Soil and Water Conservation
Other Agency
Type of Visit: omplia ce Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County Region:
'Oflor IL
Farm Name: Owner Email:
Owner Name: Q-��1 Phone:
Mailing Address:
Physical Address: �-�—
Facility Contact: 'InjL_AI to u'p—citle: Phone:
Onsite Representative: �D1� Integrator: M—B
Certified Operator: p� `fes Certification Number: L6o
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J2'No ❑ NA ] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ErNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No MN_ 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 A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ YesNo ❑ NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters El Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
Design CurrentDesign
Current
Design Current
Swine Capacity Pop.
Wet Poitltry ._
�La
Capacity
Pup.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
er
Layer
Dairy Cow
Dairy Calf
Feeder to Finish
- -
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D ltr.
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkc s
Beef Brood Cow
Qther
Turke Poults
Other
Othcr
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J2'No ❑ NA ] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ErNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No MN_ 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 A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ YesNo ❑ NA E] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters El Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili "Number: jDate of Inspection:
Waste Collection & Treatment
/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
a
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Ug.+tA-00j❑ NE
Structure 1 Structure—*—Zr Structure 3 Structure 4
Identifier: L
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(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
lid "'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
[joeo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
lam°
❑ 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
L?<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ej.-'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 EvidenceWind Drift Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L_J 1"0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes
EK
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
L io
❑ 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
LA4
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L?No
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PKo ❑ 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 R20Ko ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No D4A.' ❑ NE
Page 2 of 3 214/2011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes io ❑ 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 Ra o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ❑ NA
Other Issues /
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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 L;Wo 0 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 K3110 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes BNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes &er""
❑ NA ❑ NE
Comments:
(refer to question
#) ;Explain any YES answers and/or any additional recommendations or any other<comments, i
Use;ilraKwings'of facility to better`eaplain situations (use additional pages.'as necesiary).. r
_ rz o
a.,,t Aanoe-5'
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Cr�C
Phone: 11D Z= �.2P
Date: . AD '147 &11
4/2011

ewtS lv/zl /zo/ 0
ivision of Water Quality
tFaciGty Number 2 �Q� O Division of Soit and ONTO on ervation
Q Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
O"1fo'utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: /]- Q Arrival Time: . Departure Time: %Z,�/ f` County: 5'AN Region: y/W
Farm Name: aSG Swi",jr �a.va.. _S Owner Email:
Owner Name: --� a C� L�>>D Phone:
Mailing Address:
Physical Address:
Facility Contact: �e�.to �[.e�✓niul� /-rte" ✓ Title: 72cZ, . �sn5a/`1a^�f Phone No:
Onsite Representative: `i OiyC�`ita�/ .�f�✓_ _ Integrator:��►'�w�
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location or Farm: Latitude: =0
= = Longitude: 0 ° = I 0 W
Design C•urreut
Swine Capacity Papulation
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ NE
❑ can to Finish
❑ Layer I I
Dairy Cow
❑ NE
❑ Wean to Feeder
JEJ Non -Layer I
Dairy Calf
Feeder to Finish
❑ DaiEy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
El Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Non -Layers
Beef Feeder
❑ Boars
❑ Pullets
10
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L7Na ❑ NA ❑ NE
❑ Yes ❑ NoETNA
El NE
❑ Yes ❑ No BNA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes E o ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
Page I of 3 12/28/04 Continued

!f
Facility Numher:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: f9 I C1 A4C 0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39 ; Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes B"No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes Ivo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ ivo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes[31
o
to
❑ NA
[I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
��
B No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L'rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) BGr,AA CA -d e'k_ if7j r(::;,'a3L/ �Mk� �►^ain� 60.5.,
13. Soil type(s) 1& d Vj �lC ��//
14. Do the receiving crops differ from those designated in the CAWMP? El Yes LTNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L71Vo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes B �No ❑ NA El NE
17_ Does the facility lack adequate acreage for land application? El Yes 3< ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use addifiona{ pages as necessary):
Reviewer/inspector Name Phone: '910, s-.33 . 33 o D
Reviewer/1 nspector Signature: Date: G - / 7- 2— O/D
Page 2 of 3 12/28/04 Continued

Facility Number: 92— Date of Inspection
Reauir_ed 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 B<o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B<
❑ 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
�❑
,
1/vo
[__1 NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,E.�,
No�❑
NA
EINE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,l��,
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L.,I'N�o
❑ NA
❑ NE
25. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2<01
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
NA
[:1NE
'El
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ffNo
❑ 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
�,�
L�'fNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[INA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
VNo
❑ NA
❑ NE
Page 3 of 3 1228/04

d iv[ s Il is z 4d 9
Type of Visit (3 -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /1-�D-0 9 Arrival Time: /2i 30 Departure Time: � �� 3� County: S4= S'a7✓ Region:
Farm Name: ROs �- �[1-%� N e- �+'/� S Owner Email:
Owner Name- TTD C. Phnne-
Mailing Address:
Physical Address:
Facility Contact: _ ��..io fCGr1N Title: Phone No:
Onsite Representative: •� o w►o-4 n! /iiriL�/ Integrator:' ��_ 'gY rj
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
101/zp
Location of Farm: Latitude: [=e = =« Longitude: 0° Q. =M
Design Current
Design Cnrrent
Desigu Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
,�/
BNo
❑ NA
❑ Wean to Finish
❑ Layer
❑Dairy Cow
❑ can to Feeder
❑ Non -Layer
❑Dairy Calf
❑ No
Feeder to Finish 61610 261
❑ NE
❑ Dairy Heifer
❑ Yes
❑ No
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ La ers
on -Layers
❑Pullets
ues
❑ Turkeys
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
O#her
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
,�/
BNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
❑ No
/
3 A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ONA
❑ 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
,�,
L� <A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Bl�o'
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D -9-o—
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 2 01Ct
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z� g
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑Yes
El NA El NE
,L�',NNoo
El Yes Ld'No
❑ NA ❑ NE
Structure 5
Structure 6
Reviewer/inspector Name
❑ NA ❑ NE
❑ PAN [:IPAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
❑ Yes L7 No
❑ Yes LJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ErN. ❑ 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) r -
9. Does any part of the waste management system other than the waste structures require El[3 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes Li No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Doi< ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Reviewer/inspector Name
Phone:
❑ PAN [:IPAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [I Application Outside of Area
12.
Crop type(s) _ �VU.tq_d, C /fes'2 j 11;"I C_) �nc4Ll f�9rte:A./ �65
13.
Soil type(s) ��Q Vja.g 7--ace-vi
14.
r�•��/
Do the receiving crops differ from those designated in the CAWMP? El Yes
L� No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
2< ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
30, No El NA
El NE
17.
Does the facility lack adequate acreage for land application? Yes
E]rN
I�o[:1 NA
NE
18.
Is there a lack of properly operating waste application equipment? ElYes
2-90m ❑ NA
❑ NE
Comments refer to ' uestron Explain any YESanswers an or any�recommendations or anyFo�ther comments.
Use drawings offaciiity to better explain situations. (use addritional pages as;necessary) -}
�rY��Qfl C�.1 ✓A i 5 oCue. !N 7-0/0
Reviewer/inspector Name
Phone:
Reviewer/Inspector Signature:
Date: //' 10 — ZOO �1
1228/04 Continued

Facility Number: gZ — Jpj Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
LyJ No
❑ NA
❑ NE
❑ Yes
Q N
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
MrNo ❑ NA
❑ NE
Q05o_ ❑ NA
❑ 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
to ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[:1NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,2<o
ER o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B< ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q<o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
BNo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q05o_ ❑ 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
,�
li' ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
B No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewertinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
BNo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
9110__'_0 NA
❑ NE
Addrtxonal Comments andlor D`swngs:`�'"�` -� "
•
12128/04

&.;c -Ars 7-2)-07
Type of Visit 0"Ciompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 -/7 -OB Arrival Time: ; /S"' Departure Time: Z : Q3 County: Region:
Farm Name: �OS �, �- t—�y- S Owner Email:
Owner Name: _ R05'7-- Phone:
Mailing Address:
Physical Address:
'A%�
Facility Contact: — oLsa Leo, j Ak t(c r Title: Phone No:
Onsite Representative: Integrator: �rc.w S44. ('M " $-)
Certified Operator: Operator Certification Number: 16 7.3 S1
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ----] o E__1' E__1 Longitude: =0=' = u
Swine
❑ Wean to Finish
Design Current Design
Capacity Popularion Wet Poultry Capty
CurrentK,� Design Current
Populahod Cath 1 Capacity Population
g❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
Dairy Calf
® Feeder to Finish
&/&o
R ` ❑ Dairy Heifer
❑ Farrow to Wean
DryFoultry`�
:- ❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
-� El Non -Dairy
❑ Farrow to Finish
❑ Non -La ers
❑Beef Stocker
❑ Gilts
❑ NE
❑Beef Feeder
❑ Boars
El
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Turkeys
=-
Other
❑ Turkey Poults
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Other
I ❑ Other
'Number of Structures:
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
El Yes
��,,/�
LI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
LI No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
10 ❑ 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
ElJ
��/
L�,.NN�o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L� o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No❑
NA
❑ NE
other than from a discharge?
Page] of 3
12/28/04
Continued

Facility Number: - jp
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: 1 Z
Structure 4
❑ Yes ,L��N//a
❑ Yes ETNo
Structure 5
❑NA ❑NE
❑NA El NE
Structure 6
Spillway?:
u �r
Designed Freeboard (in):
Observed Freeboard (in): 3g 73 s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNO ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �,/
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes ETN. ❑ 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) thereat, notify DWQ
7. Do any of the structures need maintenance or improvement? [j Yes EJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Grl�o [INA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA [:1 NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [5'No ❑ NA ❑ NE
mai ntenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) err"'. -A" C L!t I�� przs-,'tet_ i S "tk C' "i
13. Soil type(s) Ale, A , [Ajq 9 j:; -c -e-14 r I -r-
14,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0< ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes EYNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 3<o ❑ NA [:1 NE
18. Is there a lack of properly operating waste application equipment? El Yes 3<go ❑ NA ❑ NE
No
,�drawtngslof�factlity to better, explain situahaus (use additional pages asnecessary} .; , ...
(S-,9Fc"
Reviewer/Inspector Name j'C -4e-k � Phone: 910, 4133. 33-30
Reviewer/Inspector Signature: Date: 7-17- Zedc5
Page 2 of 3 12/28/04 Continued

Facility Number: Sz Date of Inspection
Required Records & Documents ,,.�,,��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes E3 o [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I' No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
D� o
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
o
[:1 NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[:10 Yes
,B
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E3<
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
B N
[:1 NA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
Ell—T
ogo
,tv
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
[__1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
[❑'1
L� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,. _/
BNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El( Yes
,--,
ivo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
ErNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ErNo
❑ NA
❑ NE
Additional=Comments antl/or Drawings:
T
Page 3 of 3 12/28/04

RN( i'.4)107 �_"S
Ffidlity Number Z ��
V Division of Water Quality
0 Division of Soil and Water Conservation
0 Other -Agency
Type of Visit compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:1 b Arrival Time: ® Departure Time: County. Region:
Farm Name: 11J 1 `�Y1t'LS Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: n
Phone No•C CSL C-- �-f �rO
Facility Contact: Title: _
Onsite Representative: Integrator: 1 t Yj i
Certified Operator: Vim-- _ _ Operator Certification Number: ' I ,
Back-up Operator:
Location of Farm:
4.
T
Back-up Certification Number:-':,. .
J V /
Latitude: =0
=6
=64 Longitude: = ° = 0 u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
I@Lgeedcr to Finish d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
Pullets
U Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure [IApplication Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify D WQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current:`
Capacity Population
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IkNo ❑ NA ❑ NE
❑ Yes
❑ No
XNA
❑ NE
❑ Yes
❑ No
J9NA
❑ NE
❑ Yes
❑ No
D�NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
❑ No
1§NA
❑ NE
12/2$/04 Continued

Facility Number. — f Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yesro ElNA ❑ NE
a. If yes, is waste level into the structural freeboard? [-]Yes %No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I Z
Spillway?:
Designed Freeboard (in): 19 <-AddiV'0 b1NS
Observed Freeboard (in): q.:::�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 40 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 10 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes XNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ANo ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes No
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
0 N El NE
El NA El NE
C3 NA 0 N
❑ Yes �ONo ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
Reviewerfluspector Name C_44g.1 l_, �' Phone:
Reviewer/Inspector Signature:ILA-"Date:'
12128/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ ChecklistsI
❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/lnspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
❑ No
[�LNA
❑ NE
❑ Yes
(&No
❑ NA
❑ NE
❑ Yes
R;qo
❑ NA
❑ NE
❑ Yes
$LNo
❑ NA
❑ NE
❑ Yes
❑ No
KI NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[L10
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes Wo
❑ NA
❑ NE
El Yes Yes No
❑ NA
❑ NE
Additional and/or Drawings:
`C'omments
(Nia4cj a we d t ea m n erg C�nQ , LA� 01P
12/28/04

Facility.Np. �p� 1 1 Time In r Oq Time Out Date AZ
Farm Named ne "rO.{y_S Integrator
Owner e Site Rep
Operator ? No.
Back-up No. -
COC _. � 1Z Circle: ener or NPDES
Desi n Current Design Current
Wean — Feed Farrow — Feed
Wean
k_� Farrow — Finish
eed —l�T Gilts 1 Boars
Farrow — Wean Others
f
FREEBOARD: Design 'l
Sludge SurveyIt M fl
Crop Yield w
Rain Gauge V
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather.Codes
Waste Analysis:
120 min Inspections
Observed 3 /
Calibration/GPM 1 140
Waste Transfers —
Rain Breaker
PLAT
1 -in Inspections ✓
D Pto Nitrog n (N) Date Nitrogen (N)
.v Z 2- 3 / z(
11 � G
Pull/Field Soil —Crop Pa Window
0
C1
Q� 00
Z
Z

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:g �� d Departure Time: County: rw WAJ Region: IF i -O
Farm Name: fiod e S404U G FAr1H _ Owner Email:
Owner Name: L /�esG Phone: 6.1 /
Mailing Address: ��% _�assi�ctt �• �o,u C'-Oye .W c_ a7SP'3e--
Physical Address: de 4f
Facility Contact:
Onsite Representative: —_ tTe C_ n P_os`
Certified Operator: o ROS e-,
Back-up Operator:
Location of Farm:
Title:
/Phone No:
Integrator: �Pce-kv% i u kv%- g'fa r-aQar'
Operator Certification Number: -*14 76 S
Back-up Certification Number:
Latitude: = o = I = " Longitude: ❑ O ❑ ' ="
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder JE1 Non -Layer
® Feeder to Finish �/� 4
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design ` Current
Cattle Capacity. Population._
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures.
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [)g No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Q6 No
❑ NA
❑ NE
1212$/04 Continued

Facility,Number: Date of Inspection 1 Q1 a/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
% No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure ? Structure 3 Structure 4
Structure
5
Structure 6
n
Identifier: % d ter r cw
Spillway?:
/ q `f
Designed Freeboard (in): Q 0,
Observed Freeboard (in): -7, 3 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 No
❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
® No
[:1NA ElNE
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
IM No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[XNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) �r is
S
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?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
14 No
❑ NA ❑ NE
Reviewer/inspector Name r rC " ^;-�Ji; s Phone: moi'/O �`S_
Reviewer/Inspector Signature: Date: -z -2 �a r
12/28/04 Continued

Facility Number: g0A — / Date of Inspection Z �`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J(] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes SdNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking R 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 U No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [)d 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
91 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EK No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 i .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes]
No
❑ NA
❑ NE
A�dehoual Cei ments and/or=Drat4ii�g's�g
n
CasC �G�1,1 -fib 1+..sG CFbf, L/le � 9frr owc� � t'%.�
11 1
�i1I•,tip�

Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit QRfoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number p Date of Visit: 3 D Tune: %� OD
O Not O erational C Below Threshold
ermitted Certified ©Conditio}}n--alit' Certified Registered Date Last Operated or Above Threshold:
Farm Name: i�oSC__ SW i�� ..rA�w, County. e A
Owner Name: ..L.Yse- Phone No:..._... . �..D I(J............. ...................
N- Lv ing Address: ,..` .L, fhs! Q_ - ric'. Nt• govt !�e o 6b __
Facility Contact: �� .. _Title: _ .. Phone No:---•-
__ ._ _. W...�... _ - _ __.W _ ___.
Onsite Representative: bL iKoSC Integrator: S-}4• �.-�+
. .. .....................---------_......--. - -- ........_ .. �_ _ .. ..
Certified Operator ...1 . Q° Operator Certification
Location of Farm:
Ers/wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 44 Longitude �• �` is
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 044m
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ To
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure ;
Identifier: ............................... ............... ........
Freeboard (incites): aG 33
12112103
Structure 4 Structure 5 Structure 6
Continued

Facilitq Number: ; — w I Date of Inspection O 4
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
<o
seepage, etc.)
Reviewer/Inspector Signature: Date: 03 J9 4
/
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
0 Yes
l�kl<O
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!unprovement?
❑ Yes
19<0
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
O o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
pvc,
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Pq"; o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &Y.C'mWL 0 'n
13. Do the receiving crops differ with those d ignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
a1Vo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Io
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
13<0
15. Does the receiving crop need improvement?
❑ Yes
Ko
16. Is there a lack of adequate waste application equipment?
❑ Yes
To
Odor ]%sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ yes
ER4_0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Et
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
10
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
❑ Yesa
Air Quality representative immediately.
.�=3• - -'� � .! -'y., � F'- �!: F moi..:.., � �9x� Z., k� .,,` �,. � ti_ .-, .. R
]her comments. '`
Cammeuts {refer to qan #) _ Explain aay YFS answers and/or airy recommeoas oMieI
T15e drawings of ]betty tb better l7rpl8lllSltOStloIlS. {addrhoaaaies ssa -
x)a$ ryd COPY ❑ Final No -
:� _ � -, h} ',"..t} i.--_ ..-. `'..."SL..-- -.. _.�:.�.� ..:.�'Y'a � ��' ��x..fy���-'L"x$: �C'.�'_t`L�'q.�.-- � C'.�i.�..' �-•_ "k'�� i- �y -,�- Yy .� �� C+ �r�
Reviewer/Ias ector Name
Reviewer/Inspector Signature: Date: 03 J9 4
12112103 a Continued

Facili{y Number: — u, Date of Inspection D3 1
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes
22. Does the facility fail to have all components of the Certified Aminal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 9<0
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W4V°
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Rk90
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
C9'No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
l'vo
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
M<O
28. Does facility require a follow-up visit by same agency?
❑ Yes
+iso
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
9<0
NTPDES Permitted Facilities
s
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[g4es
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
itd �o
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EKoo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
B O
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
B<O
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
ff <o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
'120 Minute Inspections []Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddittonal Comments andlor
r_- s.—
sc.A„ t J
. G.A atn� . H,,z
5 100K 5�a Oh
D�� �'1' 811i�i11(Ga1
����-• �� ILS GDiil
�� lDt /NS`�1���� . 1�'�` ' Z`D�l d��.�
llrs b (t. �7 wi
1Vl y+^' S 1 •1
31,14 iV� cath ,
s
12/12103

Site Requires Immediate Attend w
Facility No. �_
DIVISION OF ENVIRONMENTAL MANAGEMENT' 8-L p
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8 t , 1995
Time: 2
Farm Name/Owner: M $1 J oe `�kcGe.
Mailing Address: L4 C6 l Lam: �,r CiP.w kon Grove, nc. a B3b(o
County: _ _ ScLm oeo ' - - — - --
Integrmr- M Fc.it VOA - Phone:
On Site Representative: d Phone:
Physical Address/Locauon: S. r 4'E 0f 701
Type of Operation: Swine poultry &ttic
Design Capacity: � 14 0 &J FA., Number of Animals on Site:
DEM Certification Number: ACE DENT Certification Number. ACNEW_
Latitude: N 35's jo 17 et Longitude: 2L._' _` _'
Circle Yes or No
Does the Animal Waste Lagoon haysufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inchesYe or No Actual Freeboard: _�yt a Inc
Was any seepage observed from the �7;No
s)? Yes o No as any erosion observed? Yes r N
Is adequate land available for spray Is the cover crop adequate? Yes No
Crop(s) being utilized: _ Ga , s moo -1 6-�_r'_"� rte- _ _ -
Does the facility n.,. --et SCS minirnuLl setback criteria? 200 Feet from Dwel l
ins o No
100 Feet from WellsNo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o'
Is animal waste discharged into waterso state by man -mads ditch, flushing system, or other
similar man-made devices? Yes or 1 o e If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yeas or No
Additional Comments: z— L -P\
L� a�
V,�__F.
oe.ti ('2—) O\]tr— 6, E-t--
�
C_c�• F..�� q- t2 - a L -t 4 o Q \toms
IPQ
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

AN=x.AL wAs= IGL==HMPr" PLAN CSRTIF=CATXON FOR MW OR S=PANDED FE=Z.OTS
Please return the completed fora to the Division of Raviraz=antal Xannaemant at
the add—eas on the reverse aldenof thio fez=.
Name of farm (Plea a print) Kass.-v.+r..e
Address- _ —g -i - - JJ.
j it.,..to.%, vn A N.C. X21&5 f ► 0 Phone No . • 410-, 5 7Lf - oGr4
County: So,.,psa
Fara location: Latitude and Longitude: -35 .Lai 19 /7L & 16 (required) . Also,
please attach a copy of a county road map with location identified.
Type of operation (swine, layer, dairy, etc.):
Design capacity (number of animals) : M 77,
Average size of operation (12 month population avg.) D cel !,
Average acreage needed for land application of waste (acres):
assaassaasaasaaaaassgasasaaasaasssssaassssssssasssasassassssasaaaasssaasaasaas
TechaiGal S�eafsZist C,ertifieatioa .
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant, to,015A NCAC 6F . 0005, I certify that the -new or
expanded ar;m l 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
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and water Conservation Commission pursuant to ISA NCAC ZH.0217 and
ISA NCAC 6F .0001-.0005. The following elements and their corresponding minimum
criteria -ha e_been_verified by me or other designated tec.":nical specialists and
a3ze included in the plan as applicable: minimum 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 control of the dischax-ge
of pollutants from stor=water runoff events less severe than the Z5 -year, 24-hour
storm_
blame of Tecls:siaal Spscia33st (Please Print) : /7&Rlmyy -F, a6.s
Affiliation: o E
Address (Ag } : Phone No. 59?_ -- rl (og
signature- Date: 9 2c- 9
=a�s.oragsa�sysssaassaasasssa aasssssssasssasasassasssaa�aaeaasa�aaassassss
Owner/2saaage= Agreement
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
nnvironmencal 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 -wade conveyance or through
runoff from a storm event less severe than the 25 -year, 24-hour storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Name of La=d Ower (Please Print) : Joe. Rets
Signature: � Date:
Name of 2Sast gar, if different from owner (Please print) :
Signature: Date:
Xgta: 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.
OEM USE ONLY : A0ir,: #

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.021'7(c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: R 05e-- 5�- -- -1 D
I
Flailing Address:
County:
Owner' (s) Name: _ Joe KOSie-' ; 1" "r k KaS 4 — -
manager (s) Name A:)e- 1zC'S Z
Lessee Name:
Farm Location (Be asspecific as possible: read 1
am��ieis, direction,
milepost, etc.) _ LJ�r�C iU "� :' L � 6 dy09 � IY�
d� �1y1�
4-
Latitude/Longitude
Latitude/Longitude if known:
Design capacity of animal waste management system- J(Nu erand type
of confined animal (s)) : -2
_ y 530 O as �azr• �o �-'�i\
Average animal populatio on the farm (Number and type of animal (s)
raised) : _-_ --Z4TU r1—k.kb"4 Cthlw%GLy
Year Production Began:ii-9j— ASCS Tract No. E/ %2 a _j _
Type of Waste Management System Used: Lr, dao r �l .1. rrcQ4T1 a
Y
Acres Available for Land Application of Waste: AjQp,,({r,,. ,-J , Qo qcr�S
Owner (s) Signature (s) :