820129_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

01,
2
(Type of Visit: O Co Hance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Comolaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: $! 15 Departure Time: :��' County: �Qrc M Region:�
Farm Name: (� 3 �� i 1 41� Owner Email:
Owner Name: _S f d`,t (yS Phone:
Mailing Address:
Physical Address:
Facility Contact: C a,4 i 5 ,A Title: Phone:
Onsite Representative: V integrator: - of 3 — S
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
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 DIN -6- ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
Design Current
❑ Yes
DesignCurrent
❑ Yes
Design Gnrrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Kcit. Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
1 iNon-La er
I
Dairy Calf
Feeder to Finish
Daa Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P■aultr.
Ca aci
Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 DIN -6- ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
[:]No
❑ Yes
�o
❑ Yes
❑ No
©- f�A ❑ NE
NA ❑ NE
❑�N'A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: d, - Z Date of Inspection:
❑ Yes
[ZIP ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Waste Collection & Treatment
[]..>F O NA
❑ NE
the appropriate box_
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[c3- 2C
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ Rainfall [] Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Identifier:
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
D-Igb ❑ NA
❑ NE
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Lrd 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
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
[A-Xb__
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
[k io
❑ NA
❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ oo
❑ 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 E]Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i is P ip/ 1 19 6-
13. Soil Type(s): ulelL 8 Lt,&n
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes �Io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes []. o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EIN-6- ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ ]] o ❑ NA ❑ NE
❑ Yes [3 -No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ZIP ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[]..>F 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
[-�o' ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
D-Igb ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

IFacil4 Number: 2-- ! Z Date of inspection:-//
❑ Yes
[B-Tqo-
❑ NA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[S
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3'9a
❑ NA ❑ NE
the appropriate box(es) below.
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[4-Ad6­_
List structure(s) and date of first survey indicating non-compliance:
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E T o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
M I-
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[B-Tqo-
❑ 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
Ft+<
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[4-Ad6­_
❑ 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
E;j_d6
[DNA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2-114-o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[-";To
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Stu
jv mww
�.� C00 - 3 09-
Reviewer/Inspector Name: 1 c4�w Phone: (}�
Reviewer/Inspector Signature:4 Date: Rot, I 8
Page 3 of 3 214120 )5

7'ype of Visit: U Conppliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Z�� Departure Time: � County: C-94-44 Region: 2CF20-
Farm [Mame: 3 � + A Owner Email:
Owner Name: v A_ �j �L-U44'1 Phone:
V
Mailing Address:
Physical Address:
Facility Contact: CctX4+ ?jaet,,Xt Title: Phone:
Onsite Representative: <<
Certified Operator:�-
Back-up Operator:
Location of Farm:
Latitude:
Integrator: 14/( :S
Certification Number: 16 zo-f
Certification Number:
Longitude:
Destgn Current
YDestgn ,CFtrrent'°
Design Current
SwineNMI
-CapacttyPop:
V1' et'Poultry"Capactty Pop
Cattle Capacity Pop.
❑ NA
Y
u � y.
Wean to Finish
La er
Dai Cow
Wean to Feeder 5
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Des Current
Dry Cow
Farrow to Feeder
D Poultr 4 4,:x Ga actPo 3
Non -Dairy
marrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets =
Beef Brood Cow
iiit
Turkevs .
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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?
❑ Y -es- No ❑ NA [] NE
❑ Yes ❑ No []-N-A ❑ NE
❑ Yes ❑ No [3-5-A- ❑ NE
❑ Yes
❑ No
E A
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page I of 3 214/2015 Continued

Facili Number: jDate of Inspection: 23 IIS
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
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
[3 -No ~❑ NA ❑ NE
❑ No ET<A ❑ NE
Structure 5 Structure 6
❑ Yes Q-N'o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes B"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C:fNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fNo ❑ NA 0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2 -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. 0 Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): R e,,,ov 44, 5C, V
13. Soil Type(s): l�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EllNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a' 1`0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes A�o ❑ 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
E' i�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q o
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[�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
[�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
p Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
[�No
❑ NA
[:]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Lallo
❑ NA
❑ NE
Page 2 of 3
2/412015 Continued

Facility Number: - ' ' Date of Inspection:
24. [)id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [fl�o ❑ 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 Ef'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q'IGo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e.. discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑'No [DNA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [TNo [DNA ❑ NE
❑ Yes
[!fNo
❑ NA
. ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
[/f No
❑ NA
❑ NE
(Comments (refer to question ft -Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional Daecs as necessarv).
kL,-, 0 - �-- 3-U)
rLv G
Cel( �rG �3c Cis
Reviewer/Inspector Name: Phone:
{
Reviewerllnspcctor Signature: Date:
Page 3 of 3 214/2015

hype of visit: (V Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 4EMoutine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 'ALJ Departure Time: County:- 84-W Region: W d
Farm Name: Owner Email:
Owner Name: u Phone:
Mailing Address:
Physical Address:
Facility Contact: �I Title: Phone:
Onsite Representative: Integrator:
Certified Operator: 1 C Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
11
Design Current
Design
Current
DesignPouCurrent
Swine
Capacity Pop.
Wet ltry
Capacity
Pop.
Cattle Capacity Pop.
Wean tId
o Finish
Layer
Dairy Cow
Wean to FeederHINon-Layer
I
Dairy Calf
Feeder to Finish
35S7, 3
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
Dr. Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
El Boars
jPullets
jBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ERI to ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No �NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [2'1�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 DWR) ❑ Yes [] No 31 A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ 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 21412015 Continued

F_
.
[:]Yes PT�10
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
Facility Number: r Date of Inspection:
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
Waste Collection & Treatment
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [PONo
❑ NA
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
[2 -NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
maintenance or improvement?
Identifier:
acres determination?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [:�No
❑ NA
Spillway?:
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
Fe o
❑ NA
Designed Freeboard (in):
to Incorporate Manure/Sludge into
Bare Soil
L;�No
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
Observed Freeboard (in):
Required Records & Documents
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.)
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6�tNo
❑ NA
❑ NE
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes PT�10
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [TNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
13. Soil Type(s): W
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [PONo
❑ NA
❑ NE
maintenance or improvement?
k2r'�o
❑ NA
❑ NE
Waste Application
❑ Yes
[21*17o
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [n No
(DNA
❑ NE
maintenance or improvement?
❑ NE
acres determination?
1 l . 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.)
Fe o
❑ NA
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
L;�No
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
[:]Application Outside of Approved Area
Required Records & Documents
12. Crop Type(s): fl
13. Soil Type(s): W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
k2r'�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[21*17o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ejj-Qb
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Fe o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L;�No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PEt'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6�tNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
2/4/2014 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
0 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
E3<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[rNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[5 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[J 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
[ "NNo
❑ 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 [! r% ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [2'l0o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes []<,o ❑ NA ❑ NE
Comments (refer to question ) Explain any y tions or;any other"comments.
14
Us drawings of.faciEity to better exp[sen situations (� a add hone! pages as necessary), mends. ' rpt' g
COIL 14 9 -Cl A _#
dUj
7
LIL
41 �1 I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M_
Phone: LG `T
Date:13 14 tov
2/4/2011

type of visit: �v compliance inspection V Operation Review V structure Evaluation U technical Assistance 1
Reason for Visit: (Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access 11
Date of Visit: JAI %(A4 I Arrival Time: Departure Time: County:_ Region: �(2�
Farm Name: t I t t/ 6 v a( Owner Email:
Owner Name: ` Phone:
Mailing Address:
Physical Address:
Facility Contact: CG, w _s 6 In/cettfi- Title:
Onsite Representative: It
Certified Operator: _tC
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1670e
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes M N6_ ❑ NA ❑ NE
❑ Yes [] No
[]Yes ❑ No
[:]Yes
❑No
Curren F Design Current
Design Current
Swine
Capa
M
Pop .:. Wet Poultry Capacity Pop. -,
Cattle Capacity Pop.
Wean to Finish
Layer
Da" Cow
Wean to Feeder
Non -Layer
Da" Calf
Feeder to Finish
Z
r e - r'
Da" Heifer
Farrow to Wean
{k Design Cu ent
D Cow
Farrow to Feeder
DPoult a , Grassi Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_ a
r" Turkeys
Qther
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes M N6_ ❑ NA ❑ NE
❑ Yes [] No
[]Yes ❑ No
[:]Yes
❑No
[:]Yes
[a -No
[] Yes
[fNo
EJ -NA ❑ NE
C3-iA ❑ NE
Cj NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 2/4/2011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [R -Ne~ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�� ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [(-Wo- ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes C3 -15o ❑ NA 0 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 ETNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�,No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [!'Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes [allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!J'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 Drill ❑ Application Outside of Approved Area
12. Crop Type(s)-
13. Soil Type(s):�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [g -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Z)Xo- ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [:lffo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [:�Wo ❑ NA ❑ NE
❑ Yes [:�fio ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[g-llo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q<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
[.3�<_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
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[::]Yes
�FNo
❑ NA
❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LaNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 0,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerhnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
C',( C
6 VtA C.0" -
S(u4CC�� -
Reviewer/Inspector Name:
ReviewerAmpector Signature:
Page 3 of 3
❑ Yes
1Ld'1''o
❑ NA
❑ NE
❑ Yes
[;[-No--
❑ NA
❑ NE
❑ Yes D -Ko ❑ NA ❑ NE
❑ Yes ['�o ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo
❑ Yes F�f)KNO
No
[:]Yes o
E -'V 4's ('L-0 V1 -ia 12-3r a 01
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
2/4/2014

Type of Visit: Q>�Zutine
'nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time.� Departure Time: County: 11 Regio
Farm Name: t ��/ ,� Q+/` � 0 � ner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: CLAAA45 T?P0-U L Title: Phone:
Onsite Representative: 1( Integrator: /zA 17
Certified Operator: _ lJ!/]� Certification Number: /
Back-up Operator: Certification Number: �%p� �t<J ly
Location of Farm: Latitude: Longitude:
Design .Current Design Current
rr.... .5 -
Design C►ucrent
Swine
Capacity Pope
r
. Wet Poultry ;, . CapacityPop ,_ :.
:.:..Cattle Capacity Pap.
Wean to Finish
Myer I
Dairy Cow
Wean to Feeder
z Non -La er I I
Dairy Calf
Feeder to Finish
I
Dairy Heifer
Farrow to WeanDesign
Current
D Cow
Farrow to Feeder
D = P,oul C act Pop.
Non -Dairy
Farrow to Finish;
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes D-Iqo- ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ NoPNA
E]NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) F] Yes E] No ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ 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 1 of 3 2/4/2011 Continued

[facility umber: - Date of Ins ection:
Whi to Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ1e ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Com° o><O 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 CJ ❑ 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 CTNo ❑ NA [3 NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E3'5o_ ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)-
RE
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?
l7. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
[] Yes
2<o
❑ NA
❑ NE
❑ Yes
[44o
❑ NA
❑ NE
[:]Yes
'> V
❑ NA
[] NE
EJ Yes
No
❑ NA
❑ NE
[—]Yes
Io
❑ NA
❑ NE
❑ Yes V;, `i ❑ NA ❑ NE
❑ Yes ICS' o ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 d❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C_J No 0 NA ❑ NE
Page 2 of 3 2/412011 Continued

Ili -
Facility }Number: - Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IJP-' o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 61 . ❑ 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 Ro ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [j]1"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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?
cq'(,"Y�
�rAg�y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-(r-17- Zo 13
❑ Yes [ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes neNo ❑ NA ❑ NE
❑ Yes BeNo ❑ NA ❑ NE
❑ Yes L_I "'
❑ Yes Ell-;
❑ Yes rNo
❑NA ONE
0 N ❑NE
❑ NA ❑ NE
PI ano _,
e:
Date:'
2/4/l 11

Type of Visit: (DRSmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01<utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:
Farm Name: ++
Owner Name:L
Mailing Address:
Physical Address:
Facility Contact:
i
Onsite Representative:
Certified Operator:��
Back-up Operator:
Location of Farm:
' Departure Time: County: Region: �G
i :f)"wner Email:
Phone:
Title: QfPhone:
Integrator: M6
Certification Number:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes 21 ❑ 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)
Swine
Wean to Finish
DRgn­,Current
C c Po
P *'
Wet i?oult .
}.= r5'
_ La er
Design
Ca aci
P h'
Current
Po p•
Design C•nrrent
Cattle Ca aci Po
p tY F•
Da Cow
Wean to Feeder
6
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
Non-La er
Ej NA
❑ NE
Da Calf
(:]Yes
Feeder to Finish
D , - Poul
Design
Ca aci
" "
C trent
l?o .
Dai Heifer
Cow
Non -Dairy
IJ 1""
Farrow to Wean
❑ NE
of the State other than from a discharge?
Farrow to Feeder.
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
O#her
Other
r;;
Turkeys
TurkePoults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes 21 ❑ 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
UPJ 1"'
❑ 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
Ej NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
(:]Yes
Quo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
IJ 1""
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

[Facility Nuthber: - Date of Inspection:
❑ Yes
1 No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
❑ No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X10
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
U21<A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: /
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[:]Rainfall ❑Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
Spillway?:
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
F44o
Designed Freeboard (in):
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
E] No
Observed Freeboard (in):
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O<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
[ 'vu
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑/ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
814o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R leo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
RIo
❑ 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 Drift ❑ Application Outside of Approved Area
Wind
12. Crop Type(s): C Z
13. Soil Type(s): Ukl- G,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
UKo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E],<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Fa<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Oa/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
F44o
❑ZA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
E] No
❑ NE
Page 2 of 3 2/4/2011 Continued

FaciliNumber: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes is ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes - 1R<0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 10<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No ❑ NAFEJ-d
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes Vo ❑ 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 0 o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 2<o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [3 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 2<0 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes E3/No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes !ld"'U ❑ NA ❑ NE
FCoTmme,nts (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
ings of facility to better explain situations (use additional pages as necessary).
�r�Ge-SJ2� 'L.c.►V��tr wh.+�2� � G.�-�c-J' LJ�r� -�}
Lam -
U '
-Sol
Reviewer/Inspector Name:
Reviewer/Inspector S
Page 3 of 3
Phone: `O j/,3 —3_31"XN
Date: 7119),IJ
4/2011

I
MI AM
i t457
(Type of Visit: WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance i
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: y a Arrival Time: o-?."J(!Ar'1 Departure Time: ;a County:p5A/n
Farm Name: bARA VCOD IFAR,rn Owner Email:
Owner Name: Ns t) Phone:
Mailing Address:
Physical Address:
Region: f 1 `O
Facility Contact: Fu �S A1kL­aG' _ Title: Phone:
Onsite Representative: jp��{�jp,�p, ���p t Integrator: ti„ f A
T_.
Certified Operator: 1ag R bA R A wy p E Certification Number: lo-1US
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes1d/ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ff NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [YNA ❑ 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 E?/NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes dNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes WNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued
DesignCurrent
Design
Current
Design Current
Swine
Capacity° Pop.
Wet Poultry
Capacity
Pop.
Cattle C►apacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
+,
! '
�;
Dairy Heifer
Farrow to Wean
Design
dCurrent
Dry Cow
Farrow to Feeder
Dr. $a.ul
Ca acity,
Po
Non -Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
other
Turke PouIts
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes1d/ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ff NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [YNA ❑ 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 E?/NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes dNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes WNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

12. Crop Type(s): A
I
Facili Number: jDate of Inspection: 5/4
Waste Collection & Treatment
❑ Yes
E2rNo
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eno
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[�3A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
17. Does the facility lack adequate acreage for land application?
[] Yes
[Z"'No
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�No
❑ NA
Designed Freeboard (in): iC, i
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]alio
❑ NA
Observed Freeboard (in): ?a \
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[])0f4o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ 44o
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[g�No
❑ NA
❑ NE
waste management or closure plan?
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
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
[V"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[DeNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
2/4/2011 Continued
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[B"'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[](No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): A
I
13. Soil Type(s): �Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[g"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
[Z"'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
[]alio
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[])0f4o
❑ 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
[RNo
❑ 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
[YNo
DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
eNA
❑ NE
Page 2 of 3
2/4/2011 Continued

Facili Number: a - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E:JNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EP Flo ❑ NA ❑ NE
the appropriate box(es) below. v
❑ 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 LjKo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [j�4E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3Xo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E04o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes (R/No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ["No ❑ NA ❑ NE
Comments'{refer to quest�ou #) Explain4anyg , tjansw*erslan or,, any additionallrecdihaendations ar any other comments.
iJse drawings ofLiacility to netter' zein sa�'t�'a_a_to s) us la iiitional pages"as,�ecessa , .
_ —_ - - --ry)
❑ Yes [3,***No ❑ NA ❑ NE
❑ Yes [DNo ❑ NA ❑ NE
❑ Yes Cj�'No ❑ NA ❑ NE
c.��snp-� �Rorr lud5E- SuRu�� 3-rs ur.�_l1 :;L6 13 .
G"Q 1FaCLr'r\ .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
LPya)j
Phone: 9 lo- ta 3o8'L S
Date:
2/4/2011

a
Type of Visit 1K Compliance Inspection O Operation Review Q 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:
�� t tOTyQ - Departure Time: �ol� County: Region: fm
Farm Name:( T7iJ�0� CW1� Owner Email:
Owner Name: d l l ll, 0 Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 �� Title: IJWI' l!: Phone No:
Onsite Representative:�Orb wZ IV— Integrator: M`B _
Certified Operator: C KOPP— Operator Certification Number: 1670$
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =,
= Longitude: =0=4
0=4 =
Design Current
Design Current
Design Current
Swine Capacity ..Population
Weoul
Kc.apacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
Non -Layer
❑ NA
❑ Da' Calf
❑ Feeder to Finish I
❑ No
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dai
❑ NE
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts,
El Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkev Poults
❑
Number of Structures:
❑ Other
Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
OcNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

Facility Number:181 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA EINE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q _
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
,R] No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
N No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
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
f4l No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
jg No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes
JR No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
MNo
❑ 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 El Application Outside of Area
12. Crop types) c jj)i4i &?►rc.fiia of m4 Small almhQVf� f i ry[�
13. Soil type(s)
0
v �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5? No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ER No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ERNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1 No
❑ NA
❑ NE
Commetits r-k-fer to..questton #): `Explain any, YES answers and/or any recommendattans or any other comments �
SII
Use dray Ings of faculty to better explain sttaanons ruse additional pages as necessary,) �.
.
AL
Reviewer/Inspector Name ; " + ' '' � ' � Phone 3.3.3
�ii�iJ `SCfi�r���
Reviewer/Inspector Signature: " . —� Date: G
Pa e 2 of 3 U 12/.28/04 Continued
8

Facility Number: a, — Date of Inspection
-T
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CR NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
S�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EffNo
❑ 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
tE No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,}�-
JCJ 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
[Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:rN
f W, j1 n4q-stvdye- sLrve -(bv aoto i -k AeKf cy, rer -, L6
in aY" - s.3-,
S .� be �,e
a !� aolo 6�1 Atlal J�
bf 011 `�► I. - no p4l aiq - c omaadds - I`�,���►a
wG'n6t9 04 fe(0-00 .
� ell �e � *(M
r
Page 3 of 3 12/28/04

Facility No.�63-0-01 Farm Name bq-3 {be_ Date iai�
Permit _�� COC ✓ OIC—Z NPDFS (Rainbreaker PLAT Annual Cert )
Pop. Design Current
Type
'S
FB
Drops
sesign treeboard -------
ltbserved freeboard (in)
Sludge Survey Date
Sludge Depth (ft) "' Oak
Liquid Trt. Zone (ft)
Ratio Sludcje to Treatment Volume
Actual • rr.�-------
r -MM.
F�li_-------
Soil Test Date 11 jjgj0?
pH Fields
Lime Needed
Lime Applied
Cu -I ✓Zn -I
Needs P
Crop Yield /
Waste Analysis Date
N Amt (Ib11000 Gal)
Wettable Acres -�
WUP _r
Weekly Freeboard ✓
1 in Inspections
120 min Insp.L�
Weather Codes
Transfer Sheets VT
RAIN GAUGE
Dead box or incinerator
Mortality Records
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
!r� c
O
S st --
Verify PHONE NUMBERS and affiliations IT �y�
Date last WUP FRO Date last WUP at farm ,7
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
App. Hardware
4)Y
7

Y
ivision of Water Quality
Facility Number lZ9' O Division of Soil and Water Conservation
O Other Agency
Type of Visit ompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
�-kqs erv4YGJ_ Ia-OZ-"09
F) U -T ^
Date of Visit: - Arrival Time: / d Departure Time: /. County: =E4. Al Region: 1104/
Farm Name: BMI B `bays �Al'' Owner Email-
� / �
7-1
Owner Name: �/ �r �1 r e' Phone:
JI
Mailing Address:
Physical Address:
l a i'lo a -¢—
Facility Contact: ,> r ,� Title: OG[!/t/C'L�s ffffjjJJPhone No: Q
Onsite Representative: Integrator: /�Ll�O'D oeglV1, Al
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =0 =1
Longitude: =0=, °=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Q ❑Non -Laver
Dry Poultry
❑ Layers
❑
Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife3
❑
Dry Cow
❑
Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
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 E No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑Yes No LINA
EJ NE
❑ Yes ❑ No WA❑
NE
El Yes E NNoo El NA
El NF
Dyes M o ❑NA
EINE
12/28/04 Continued

V
Facility Number: 1?2-
Date of Inspection
Waste Collection & Treatment
/
a
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yeso
-NA
El
a. If yes, is waste level into the structural freeboard?
[:]Yes
No ❑ NA
EINE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fo ❑ 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 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2igo ❑ 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 LT No LJ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes a<o ❑ NA ❑ NE
maintenance/improvement? ., [I NA
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes a o [I 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!! A `
]2. Crop type(s) 19�; .{�Z.. t! �+�ta.l� � rN Cd'5-' i - 'f AVA/ 4.r
13. Soil type(s) UJtt. ,[� /cc i n/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
[�No[E:3
NA
NA
10 ❑ NA
��No NA
❑'No LI NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
e,ssoem
drawings tertogtiestion #jEgp erns yYuESersand�/oriany ecomtrtendations ar apy other comnnents.
of factll ' to better ea lata situations. aseladdttlonalh a es,aspnecesss .
/
a
ReviewerAnspector Name Phone: yT_-_- 333
Reviewer/inspector Signature: Date: 9
Page 2 of 3 12/28/04 Continued

w
Facility Number: $ 2 — %15► 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 L`1No ❑ NA ❑ NE
❑ Yes NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
Gj ❑ NA
❑ 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
�o
[:1 NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
ElL
,L�_T
o
❑
[:1NA NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
am�_
vo
El NA
❑ NE
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L�'1��
Ng�o
[_3 NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,L.��,,
L�'No
[:1NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
B'No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L��"Noo D NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
Gj ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
a o ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
AdditlonalaCOmi" mentsiandlOraDrawrngs
P
12128104

•
IMS ,)S 0610W
Type of Visit (Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Q Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1(J Arrival Time: ,00 Departure Time: �* County: Region: 1 ft
Farm Name: I 9- �U 90 _ Fj2(M Owner Email: (-
Owner Name: g' _ Phone: 5'4 i 1333 rl
Mailing Address: f K Cl # N
Physical Address:
Facility Contact: Ba- b&11 _ _ Title: n ir u Phone No:
��' I f4oI
Onsite Representative: � Integrator: HU1g�11')
Certified Operator: i3r f4nge— Operator Certification Number: t A 16109
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I
0 LL Longitude: = ° E__1 I 0 u
G en
Swine Dpiig ty Populati n WetP Itry C pag ty pop la ionJ'Cattle
n
❑ Yes
n @urrent
CapagC ty Population
❑ Wean to Finish
❑ Layer
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
❑ Dairy Cow
Wean to Feeder 4310
❑ Non -Layer
a. Was the conveyance man-made?
❑ Daily Calf
❑ No
❑ Feeder to Finish
v,_M
- '-�` -j'
❑ Dairy Heifer
❑ No
❑ Farrow to Wean
Dry�P,oultryxi
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Dry Cow
❑ Farrow to Feeder
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Non -Dairy
❑ No
❑ Farrow to Finish
❑ La ers
2. Is there evidence of a past discharge from any part of the operation?
❑ Beef Stocker
19 No
❑ Gilts
❑ Non -Layers
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Beef Feeder
]§ No
❑ Boars
❑Pullets
other than from a discharge?
❑ Beef Brood Co
ElTurkeys
Page I of 3
12/28/04
Continued
.
Other❑Turkey
Poults
❑ Other-
0 Other)
Number of Structures: Q
-x`
_ _
A -
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JZ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
19 No
❑ 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 I of 3
12/28/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes �?No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ._
Observed Freeboard (in): Dq
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes J9No ❑ 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 19 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [--]Yes ISNo [INA ❑ 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 CffNo ❑ NA EINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C'No ❑ NA ❑ NE
mai ntenance/improvement?
11- Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tjrNo ❑ 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)C 0 -fat k�rm 44 Tirli!J
/ �'✓fnT�, 13W12
Reviewer/Inspector Name M204S alai r l' Phone ADD
Reviewer/Inspector Signature: Date:
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
10 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
tR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Comments�fer #o uestion.# E 'lain anv«� �r an recommendations o...r an other cowmen
UseRia'``` of facth to better exiam situatYionsg use addtt<ott �� y '�"'� )� y Y � � �"�
d al a es as necessa
Reviewer/Inspector Name M204S alai r l' Phone ADD
Reviewer/Inspector Signature: Date:
Page 2 of 3 V 12128104 Continued

I.
Facility Number:$ —1114Date of InspectionQ Q�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes $a No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists [:1 Design El Maps [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge`?
❑ Yes
D9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
12 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
t9No
❑ 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
19 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
tffNo
❑ 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
29 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
19No
❑ NA
❑ NE
...
Additional Comments and/or Drawings:;:- t
_._
r PXeaft -�-fcm S I�d� VrVe far a 009
y
W0104a7eSAaoo R
gn,5011 Som�� oto+✓
+]or new V -eel
��� 3,aGbS'�
y
Page 3 of 3 12/28/04

Q 4 frprt%(,Itzh 4 CO- P�
Facility No.Farm Name $1�D/b6A- Date
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert )
- - .... vo©o©o�■vi
Sludge Ikepth (ft)
Calibration Date 1 2 3 4 5 6 7 8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test a rag 1q.5 /,
pH Fields pH Lagoon_
Lime Needed
Cu
Zn
e�tab AceLdje��i�aoQ�i
Crop Yield
Rain Gauge
Weekly Freeboard
a4L�
Waste Analysis Date
Elm=,
411 t7 IM Califf
Rainfall >1"
1 in Inspections
120 min Inspections
Transfer Sheets
-Zv�k c,jA- h P13
Pull/Field Soil Crop Pan Window
No- Oct
,S'

� r �
0 Division of Water Quality
Facility Number (,Zq 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �� Departure Time: O°i= Q County: Region:
Farm Name:��yy , jfDt Owner Em/ail: \
Owner Name: X71 f C' D Phone: 9- 533- -13a3
Mailing Address: j� _ �Ine Imo, �_1` r QtX,4n A)C aa3a8
If
Physical Address: ],
Facility Contact: Bilk ► f e Title: Phone No:
Onsite Representative: n Un] 6 Q Integrator:
Certified Operator: al ba-ra Operator Certification Number:
Back-up Operator: 1J�1 f L/ C r � Back-up Certification Number:
Location of Farm: Latitude: =0 a Longitude: °
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -Layer
Dry Poultry
La e
Non-
U Turkev Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes P No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No 0 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No P NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes IM No El NA [:3 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes [TNo ❑ NA ❑ NE
other than from a discharge?
11/28104 Continued

Facility Number: + Date of Inspection I to/F�p'J_j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [PNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ®.NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?.
Designed Freeboard (in):
er
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
P No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
43 No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[R No
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
J§ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
b No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ Yes
0 No
9. Does any part of the waste management system other than the waste structures require ❑ Yes[
No
ElNA C-1NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
PONo
❑ NA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
95No
❑ 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 Accc��eptablrblelI Crop Window ❑ Evidence oef Wind Driiftf F-1Applicationof Area
IOutrssiide�
�
12. Croptype(s) l_QZST(>✓l�Gam . S�t��[�--
13. Soil type(s) ljoclray" — tk)a'g
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
E,fceIIes.v+ Else►.
�,164 P,,,dc
Reviewer/Inspector Name P LlaftPhone:
Reviewer/Inspector Signature: 0, AV A4Date: O
12/28/04 Continued

,
F,
Facility Number: — ;'t Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 PdNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E 'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
19No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EP No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(�No
El NA
[__1 NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[A 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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JJ9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Sf t�oi e P.'Ova l Co,^.,pf e o r` !1'larct►
i 5 s+ I I a (rAos+ e LOA -),e ( -f vo
LLt9 0o n � f�7
12/28/04

r
Y
Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
-t_ Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ©/=Q Departure Time: G� County: s� Region: )9210
Farm Name: V � POOL a�M T� Owner Email:
�i �! Phon
u tJ�0. !-[4��Q _ er� �3 3 383
Owner Name: Q T_
Mailing Address: I` .283a
Physical Address:
Facility Contact: Qt 11y Title:
it
Onsite Representative: }�
Certified Operator: _T ' ' ! D �
Q
Back-up Operator: '✓' �_ I_ C'`1�3 P� _
Phone No:
Integrator:
Operator Certification Number: /6707 �
-
Back-up Certification Number: 16708
O8
Location of Farm: Latitude: [= o [� 6 = « Longitude: = ° [= 4 [� q
Desl
gn� GurrentM�}Design Current Design C*nrrent
Swine @apacity P�opulatiari We JP4Ui try��Capacity Populatson Cattle Capacity Population
. �..
❑ Wean to Finish
® Wean to Feeder �j
❑ Feeder to Finish ` '
q , �� L1 Dairy Heifer
❑ Farrow to Wean' ❑ D Cow
Dry Poultry p"`"
❑ Farrow to Feeder
❑ Non -Dai
❑ Farrow to Finish ❑ Layers V. ❑ Beef Stocker
❑Gilts ❑Non -Layers El Beef Feeder
❑ Boars „` ❑ Pullets
w;, ❑ Beef Brood Co
:: ❑
Turkeys --
Other t y x w`�.'
ymT
r TurkeyPoults y:
❑ Other? ❑ Other Number of Structures:
❑ Layer
❑Non -La cr
Yes XNo NA 0
El E] N
NA
❑Dai Cow
El Dairy Calf
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)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page 1 of 3
❑ Yes ❑ No VI
12/18/04 Continued
NA
❑ NE
❑ Yes
❑ No
[� NA
❑ NE
INA
❑ NE
❑ Yes
❑ No
❑ Yes
� No
❑ NA
❑ N I✓
❑ Yes
� No
❑ NA
❑ NE
12/18/04 Continued

ComEnents (refer io question #): Explain any YES` answers and/or'any recommendations or,any"other comments
:Use drawings:of facility to better explain situations (use addtttonal.pages as necessary)Aw
i�-Xc el l e4 Farm
ceIle Retr�s
Facility Number:
Date of Inspection
Reviewer/Inspector Name
Waste Collection & Treatment
Reviewer/Inspector Signature:
,,��cc,,
6
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
[N NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
1 denti fi er:
Spillway?:
Designed Freeboard (in): I�
Observed Freeboard (in): s�3k
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
)9 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
P9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[__1 Yes
g] 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
g No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) FeI u4et f►►�i n14"1441
1-12
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
54 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No ❑ NA ❑ NE
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
N No
❑ NA ❑ NE
ComEnents (refer io question #): Explain any YES` answers and/or'any recommendations or,any"other comments
:Use drawings:of facility to better explain situations (use addtttonal.pages as necessary)Aw
i�-Xc el l e4 Farm
ceIle Retr�s
Reviewer/Inspector Name
_ ^ Q.:. —_�� Phone: 9/D��j�?U P
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12/28/04 Continued

Facility Number: a — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V 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
N No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
5Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
EA No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(9 No
❑ NA
❑ NE
Additional Comments :and/or Drawings: ;;� r .. ti IMEN
Page 3 of 3 12128104
Page 3 of 3 12128104

0
Type of Visit 0 Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3` p Arrival Time: g! Oa., Departure Time: County: afaej_- Region: f�O—
Farm Name: &A, 11.4 _ 16a-piaea_ leve rc�r•.., Owner Email:
Owner Name:y i Qa�6ars Hp,�r Phone: - 9/0
Mailing Address: 1462 e _a g —Of A0011 C �f7ew NC _ 7 Q3Z 9
Phvsicai Address:
Qpr 6a�
Facility Contact: Hoge Title:
Onsite Representative: '64f4
wru uuHue _
Certified Operator: B.111e _// 1`op
Back-up Operator: Q04a „_ _-/Howe.
Location of Farm:
Design Current
Swine . Capacity Population
❑ Wean to Finish
Q' Wean to Feeder h IOO
❑ Feeder to Finish
❑ Farrow to Wean '
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: 0! to .//.s,
Operator Certification Number: /�o 7�
Back-up Certification Number: /-/707
Latitude: 0 0 = 0 Longitude: =0=& °=
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et 4=
Dry Poultry
❑ Lavers
❑ Nan -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current .
Cattle Capacity ` Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow t
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (Ifyes. 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 2<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
21 o
El NA
El NE
❑ Yes
[a&o
❑ NA
❑ NE
12128/04 Continued

8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[3 -No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
Facility Number: Date of Inspection - ay
9. Does any part of the waste management system other than the waste structures require ❑ Yes
allo
❑ NA ❑ NE
maintenance or improvement?
Waste Collection & Treatment
Waste Application
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[INo
❑ 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
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Structure 6
+.,
Identifier:
7 7 T /pt7
Spillway?: /l o
Designed Freeboard (in):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
allo
Observed Freeboard (in): 31"'
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
2N o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
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.)
�io
❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
[allo
❑ 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
RrNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[3 -No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
allo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
allo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
('No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
7 7 T /pt7
12. Crop type(s)
13. Soil type(s) {d/n
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
allo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
2N o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA �E
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA ❑fiE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
�io
❑ NA ❑ NE
Reviewerllnspector Name - LSrnm�l/J Phone: 11/0 -Lf 2& '16.w e./ '730
Reviewer/Inspector Signature: Date: ,3 ` rl-Drr
12/28/04 Continued

Facility Number: — /may Date of Inspection j- 29•e
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 2'<es ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 -Ko ❑ NA ❑ NE
the appropirate box. ❑ rpm- ❑ Che fists ❑ Dog ❑ mw' ❑ og)eP
21. Does record keeping need improvement? If yes, the the appropriate box below. EKes ❑ No ❑ NA El NE
2-r8�.7•'Z 12-10-) T.L
❑ ❑ Weekly Freeboard ❑ -V ❑ his ❑ ❑
❑Rein*sil ❑ 6toekiftg ❑ Crop Yield ❑ Rv4onthly and 1" Rain Inspections
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/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 -Flo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
2NE
❑ Yes
❑ No
❑ NA
214E
❑ Yes
❑ No
❑ NA/❑SNE
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ErNE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
FrNo
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes O'No ❑ NA ❑ NE
Additional Comments and/or Drawia s
41 Y. `
1 `1. PPor�rKer S�{e.% %�ja.� flrrr
1rr�r nod
rtCt.'�r� tlr n�r�.Pcr.,..� a.rr/ Cs.i•'f;�,a/e
of Ce,.tragr. 2iLs�tc{a. w' /1
6jirc/f v�
>ti'i•'S u�c� n+s�,'I a .ler.. c a/my .
i• %roo✓vrrE^ ••s krrP'''9 a//
�iere�r�i
!'etrr�%s. P/rate rec / , y f ,tea e.�
Ott/ f dr 7✓! 17
o
12/28/04

A
of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
�
Facility Number Date ofVisit: -0+�7 Time: —
O Not Operational O Below Threshold
Permitted 10 Certified © ConditionaUy Certified [] Registered Date Last Operated or Above Threshold: �__ —•
f t"~ Q
Farm Name: �!.�� i0a,-� f�ilc G �arr►� County:.._._..._ am t:v�J .._! i�,,.,,.
Owner Name: Phone No:
Mailing Address:........ 4�a . -•ti.4 ....... ....... ..I..........
Facility Contact:
Tide:
Phone No:
Onsite Representative: •--....... �-........Integrator: ,
__.�.....+� �..�.............. G r'.: a � ..._..»......
Certified Operator: ,�.�.�, ..o G Operator Certification
Location of Farm: !
Of Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 && Longitude & 4 64
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ....... _..(.................. _._........ _ _ .. _.__._.
Freeboard (inches): 21.2 j I
❑ Yes ❑ No
/V 114
❑ Yes ❑ No
❑ Yes [12 No
❑ Yes P No
❑ Yes 0 No
Structure 6
12112103 Continued

Facility Number: .I —1a'9
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6_ Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes [V No
❑ Yes 4 No
❑ Yes ] No
❑ Yes No
❑ Yes [�No
Waste Avolication
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[Iq No
11.
Is there evidence of over application? El Excessive Ponding ❑ PAN El Hydraulic Overload
El Yes
M No
12.
Crop type /,JG r at Xa I �A Y / CS C_? V c V- S c !rX
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
09 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
M No
N No
b) Does the facility need a wettable acre determination?
❑ Yes
M No
P No
c) This facility is pended for a wettable acre determination?
❑ Yes
[P No
15.
Does the receiving crop need improvement?
❑ Yes
[O No
16_
Is there a lack of adequate waste application equipment?
❑ Yes
[, No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[Q No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: " 67 7
(ie/ W UP, checklists, design, maps, etc.)
❑ Yes
O No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[6No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Vallo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
P No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
[29 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cambtents (refer to question #) Ezphtln uu 'YES.unswers aadlor y t eco�nn neniiatitttas;ar an arther eammen#s. �
yip{
u -_ �.�
i3se tlrawtngs of fadity to better explara srtnattatis: (u a adtiap aal es ss necessa ) Fteid Conv _.: ❑Fina 1 Notes E
�.._ -...
d .:. , :•.:..=.:;, :' . . - ,W'.
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: " 67 7
05/03/01 V
Continued

Site Requires Immediate Attention:
Facility No. 92- " / x
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address: %7
County: 5M}-m� 2 56
Integrator:
On Site Representative:
Physical
Type of Operation: Swine
Design Capacity:
DEM Certification Number:
Latitude: °
DATE: 1995
Time: ?-;
r/ Poultry
Number of
ACE
Longitude:
Phone:
Cattle
Animals on Site:
DEM Certification Number: ACNEW
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)or No Ac Freeboard: Ft. Inches
Was any seepage observed from the agoon(s)? Yes or &Was any erosion obVeor'No
edes or�
Is adequate land available for spray? Y6.r No the.cover op adequate?
Crop(s) being utilized: 0C.
Does the facility meet SCS minimum setback criteria? 200 Feet from
or No
100 Feet from Wells? Y-es/or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 1
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(N:5)
Is animal waste discharged into water ofd state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(NW If Yes, Please Explain.
Does the facility maintain adequate waste management recor (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?es or No
Additional Comments:
Inspector Name
Signatu
cc: Facility Assessment Unit Use Attachments if Needed.

JUL 14 '95 11:46AM
NORTH CAROLINA DEPARDMiT OF LWMOM=, HMALTH & IAMZAL RESOURCES
DIVISION OF MWIRONME NAL MANAGMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
r ram( PlumDi$4$R _` ---�. -sem
`-MPECTIFARK ifl@lHSR�-- � ..
ZLLY 4t)Ps
7 Z51 45
w< '.,x1►iY.TNG�1DnRESs .��rAC:r ITY.IzEmrdonx.-NUMEER' . a
_Ars. 8py, 4r(- CL twmg 533 -3331
All. questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
imal 0 eration Type:
Horses, cattl in poultry, or sheep
SECTION II
Y 1 N
1. Does the number and type of animal meet or exceed
the (.0257) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)] •
2. Does this facility meet criteria for
Animal Operation REGIS TRATiaLi.
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a CStTMM ANnQLL
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage With
specific cover crop)?
b. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
M

iu� vu vu civ vc..�
,SECTION III
�� Field Site Mamma em �t
r
1.
Is animal Waste stockpiled or lagoon
construction within 100 ft. of a DSGS
Map Blue Line Stream?
2.
Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3.
Does this facility have adequate acreage
on which to apply the waste?
4.
Does the land application'site have a
cover crop in accordance with the
CIIiTIPICATION PLAN?
S.
is animal Waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
b.
Does the animal waste management at this
farm adhere to Best Management Practices
(BPLD) of the approved C TMCATICN?
7.
Does animal waste lagoon have sufficient
freeboard? How much? (Approximately}
S.
Is the general Condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION iV
Com. -n en t s
JUL 14 P55 11:4iDm:"1—