820143_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

hype of visit: LyCoroutine
nee Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: J u Arrival Time: r D Departure Time: County: PS f fl)
Farm Name: ��rl ►'l ���yLL Owner Email:
p
Owner Name: ocf c il piy S .Phone:l n�
Mailing Address:
Physical Address:
Facility Contact: Ct u 5 (3 a v --t , t e- Title: Phone:
V
Onsite Representative:
Certified Operator: .4 CL
Back-up Operator:
Location of Farm: Latitude:
Region: IfZE-
Integrator: EL p S
Certification Number: ! 4L 0 4
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 e-igo ❑ NA ❑ NE
❑ Yes
Design Current
H` -A
Design
Carrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
2450 O
Dai Heifer
Farrow to Wean
Design
Curren t
D Cow
Farrow to Feeder
D . P,oui
Ca aci
P.o
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Z111 61
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 e-igo ❑ NA ❑ NE
❑ Yes
❑ No
H` -A
❑ NE
❑ Yes
❑ No
I _l NA
❑ NE
❑ Yes
❑ No
[3 NA
❑ NE
❑ Yes
[a -No
❑ NA
❑ NE
[]Yes
Q'No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili ,Number: -ZLI jDate of Inspection: .
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3.111_ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No QUA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�J<
❑ NA
Spillway?:
the appropriate box.
Designed Freeboard (in):
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
Observed Freeboard (in):(' -7
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[a -Vo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ ,,N6—
❑ NA
6. Are there structures on-site which are not properly addressed andlor managed through a
❑ Yes
110
❑ 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
U� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[S[ -No
❑ NA
❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes B< ❑ 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): G (3 — �� y
13. Soil Type(s): LA.)4
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [c].l'd'G ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ER --Ko- ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Eql�o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[b -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�J<
❑ 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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ ,,N6—
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesIo
❑ NA
❑ NE
Page 2 of 3 214/2015 Continued

[Facility Number: Z- ,3 Date of Ins ection: c,c
24. Did the facility fail to calibrate waste application equipment as required by the permit? C]Yes [I -5-o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 11 4o ❑ 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? ❑ YesNo[] NA [3NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 044m [] 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 ❑ Lagoor /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 to ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes 2<0
❑ Yes No
❑ Yes D -10 -
E] NA ❑NE
NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer,�o;guestion #I): Explain any YE5 answers andlor any additional recommendations or -any other. comments. WyNa
Use :drawm of5facili to better a lain situah's'k use.adAWonal pages as necessary).
5&47e
e E `�
Reviewer/inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
PhonerW 0- -[ 3 3-333
re: Date: I V
21412015

Type of Visit. rE) 7Routine
pliance 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: �I Region:
Farm Name: j kY-( utlut/-5 P F..c_vV­k Owner Email: [
Owner Name: "C_"4,4 Phone:
Mailing Address:
Physical Address:
Facility Contact: .wi"1 5 ��(c� (,UL` Title: Phone:
Onsite Representative: a Integrator: �. Li 13—
Certified
J—Certified Operator: , { Vic,, , LSP Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
aDestgn
Current
[B<A
Design Current
Design Current
SwineCapacttyPap.
Wet Poultry
Cap ctty'Pop -
Cattle Capacity Pop.
El—No
❑ NA
❑ NE
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
- Feeder to Finish
So z 0
=
*Design Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
.-.
a�aciPo ., :...
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
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 [D-N—b ❑ NA ❑ NE
[:]Yes ❑No
[:]Yes ❑ No
[Y NA ❑ NE
ErNA'
❑ NE
❑ Yes
[] No
[B<A
❑ NE
❑ Yes
[E'1Qo
❑ NA
❑ NE
❑ Yes
El—No
❑ NA
❑ NE
Page I of 3 2/4/2015 Continued

Fa;.ili Number: Date of Inspection-
❑ Yes
0 N
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
Q o
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
l�`r""
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[J' 1�A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
io
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
Observed Freeboard (in):
20. Does the facility fail to have all components of the CAWMP readily available? If ves, check
❑ Yes
E3<o
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
EA -Ko—
❑ 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
fo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LJ o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
a i�o
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej -No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 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): '56
13. Soil Type(s): 1/0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E3<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
is
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If ves, check
❑ Yes
E3<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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall E] 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [5/No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

FeciliNumber: , Date of Inspection: 71
12 <o
❑ NA
❑ NE
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
E3<o
❑ NA ❑ NE
the appropriate box(es) below.
No
❑ NA
❑ NE
❑ 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
C:Ko
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
to
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Yes
12 <o
❑ NA
❑ NE
❑ Yes
No
[] NA
❑ NE
❑ Yes
E3No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes LJ 1VO
❑ YesEl"No
[:]Yes [ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawm s..ofCa ility to better explain situations; use additional pages as necessary).
ct
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:To 43 J
Date: I b L]
21412015

I ype ui v isu: %v x,ompuance inspection U iyperation xeview U niructure r vamatnon U i ecnmc31 Assistance I
Reason for Visit: QfRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:2r , Arrival Time: Departure Time: County: %Yk^
Farm Name: U`YTr (Zhu f Owner Email:
Owner Name: PN[ Fc."Ls R%t6ayrXC4LO"PIT Phone:
Mailing Address:
Physical Address:
Region: r"1 ` y
Facility Contact:{S 1504rW Title: Phone:
Onsite Representative: l ( Integrator: —
Certified Operator: Z L cr"4Ji a4' Certification Number: q C 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation? ❑ Yes E;Ko ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [—]No [31NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No �lA ❑ 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 ff No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes UNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3
i
1/42011 Continued
Desagn Current
DesignCurren[ �=
Design Carrent
Swine
Capacity fop.
Wet Poultry
Capa ityP�op-
Cattle Capacity Pop.
..
Wean to FinishLa
er
Dai Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finishca
i�
`'
Dairy Heifer
Farrow to Wean
DCow
Farrow to Feeder
FDRiP.W4rre.,n1t1.,.:..,__
a acs; "l?o'.
Non -Dai
Farrow to Finish
Beef Stocker
Gilts
krs
Beef Feeder
Boars
Beef Brood Cow
erOther
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation? ❑ Yes E;Ko ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [—]No [31NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No �lA ❑ 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 ff No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes UNo ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3
i
1/42011 Continued

Fa6li Number: - Dateorinspection:
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
Identifier:
❑.MFT—❑ NA ❑ NE
❑ No E+K( ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):T
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [j]oNo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
[2No
❑ NA
❑ NE
waste management or closure plan?
[:]Yes
[2***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
[;Kqo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[21f�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2*No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[ITNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [B"Vo DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):GhT'h— -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [fr*lqo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes [E o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�JKo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�No
❑ NA
O'NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[2***No
[] NA
❑ NE
Required Records &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesFZ/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑LeaseAgreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3 No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [✓"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes Fj"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

[FfaMity Mthiber: - Date of Ins ection: Wo LAL
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®-Tqo— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 0 -Ko 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 to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA .❑ ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes E"No ❑ 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 file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [2 No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes E3/No ❑ NA ❑ NE
❑ Yes E]O<o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes ff No ❑ NA [] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes &No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [a'No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers andlor-any additional recommendations or,anyTother.comments:,
Use drawings of facility to better explain situations (use additional pages as necessary).
Q,j li,4, r /&- 3- /'�
[-2,-3 - 0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: kf37
r33
Date: �C
*wl � 1
214120)1%#

i ype or v isn: V.ompuance inspection U tiperation xeview U Structure kvatuatton U i ecnnicat ASSIStance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f Arrival Time: Departure Time: County: c—r r Region:aa
Farm Name: n I V I- t Ck a,(1iS Owner Email:
Owner Name: Y-' JP P.tJ'I+VJ—1+ZtGt%LA-t-i C jphone:
Mailing Address:
Physical Address: J7
Facility Contact: cu c S 5 & tJ ` Title: Phone:
Onsite Representative: L 4 _ Integrator: AJ?
Certified Operator: i�G(/l C�-c�� t�1 Certification Number: C L _
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?
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 [3-NO—C] NA ❑ NE
❑ Yes [] No U -NA- ❑ NE
[:]Yes ❑No [~ ❑ NE
❑ Yes [] No
❑ Yes [3 -No
❑ Yes O�No
D-K'A
Design Current�� �� a- RE�,..
Design
Current -T_
- Design Current
Swine
Capacity Pop. - � ��Wet Poultry
Capacity
Pop �
�-�`
'Cattle Capacity Pop.
V
Finish
La er
Da' Cow
Feeder
Non -La er
*
Da' Calf
o Finish
a 5d :TOCc7 �
TM y .
Da Heifer
o Wean
EFarrow
Design
Currents -
D Cow
o Feeder
flD .foul ",
Cai
P,o
Nan-Daio
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Qther
Turkey Poults
Other
u «P
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [3-NO—C] NA ❑ NE
❑ Yes [] No U -NA- ❑ NE
[:]Yes ❑No [~ ❑ NE
❑ Yes [] No
❑ Yes [3 -No
❑ Yes O�No
D-K'A
❑ 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 Q-Nto­­❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NoW]_NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EaNcr`_ ❑ 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 [�[:] NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑�o
D NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-<
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
rT: o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2 -go
❑ 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): fs'r'-'c'S 6 () T
13. Soil Type(s): 1
14. Do the receiving crops differ from those designated in the CAWMP?❑Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes EZ[+f° ❑ NA ❑ NE
❑ Yes [3' o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 [24o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facili Number: 71 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZN6_770 NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Bg1t6_ ❑ 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 [2--Ko�' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:Wo ❑ 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:
❑ Yes [3,<o ❑ NA ❑ NE
❑ Yes [3 o ❑ NA ❑ NE
] Yes EfNo ❑ NA ❑ NE
❑ Yes [21"No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [–]Yes io ❑ NA ❑ NE.
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [3<o ❑ NA ❑ NE
Comments (refer to;question #f): 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). , ..,
5(w� �9__ — ( 7,- � f-- /L(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
- .S, l FrL<.21
Phone: M_ az2&
n4 r
Date:
2/412014

Type of Visit: CeMom nee Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other
0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: RegiFg_
Farm Name: b'l'v"ev ( 07)C' YdCI Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
®11_ /w'l
L
Title:
Onsite Representative: f�
Certified Operator:
Phone:
Phone:
Integrator: ���Y vt9l-
Back-up
Certification Number: C
Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑-?
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current .N
Design
Current
Design Current
Swine
Capacity Pop. We# Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
❑ NoFj'_NA
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
❑ Yes
❑ No
NA
Dairy Heifer
Farrow to Wean
T. u,
Design
Current
Dry Cow
Farrow to Feeder
D57Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
r
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑-?
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ff'N�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ NoFj'_NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
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 2/412011 Continued

Facili •Number: jDate of Inspection: .'
Waste Collection & Treatment
4. fs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ZLNw--0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No 4❑ -A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P "" ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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 U_ - ❑ 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 100 ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication /�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�] ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cro Window- Q❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): e.4t/"t/�f l � G
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [5-V`F ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ "190 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Pg -Ko ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0-<o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�['No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [::]Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo ❑ 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 Inspectio ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑Yes yNTNO ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

91 Facili Number: - Date of Ins ection:
24il . Did the facility fail to calibrate waste application equipment as required by the permit? Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej>d-�_ ❑ 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 Ej< ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FTNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes L(d'r"o ❑ 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 S_1Qo ❑ 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 P-1� 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
MXo- ❑ NA
❑ NE
❑ Application Field 0 Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesX10
1:1 NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss rcview/inspection with an on-site representative?
E] Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Zo❑ 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). ''.
Gj
• YW �� V ��
c
Reviewer/Inspector Name:
Reviewer/Inspector Signature: __
Page 3 of 3
4
PhonR V"' -. 3j_ IM
Date: J
214/2011

Type of Visit: (]Vompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: QR'outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
5 3�-� ' �A
Date of Visit: ® Arrival Time: Departure Time: '3 County: Region: //�
Farm Name: P , M , yflR M
Owner Name: C 600S �nC.
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: C-1 Lj(ximnp Title: Phone:
Onsite Representative: !�q TCN F � Integrator:
Certified Operator: �,��p Ec�►w�iz RS Certification Number: 01
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
IdEq
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
ONE
❑ Yes1�No
Non -La er
❑ NA
❑ NE
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
SCJ a b
�,
Dry Poul
La ers
Design
Ca aei
Current
$o
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Fullers
Beef Brood Cow
zu
Qthe N
Othcr
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
I
❑Yes [Ko 0 N 0 N
0 Yes 0 No E]a A ❑ NE
❑ Yes ❑ No L y lamA ❑ NE
❑ Yes
❑ No
[t/ NA
❑ NE
[—]Yes
[]?'�o
❑ NA
ONE
❑ Yes1�No
❑ NA
❑ NE
Page I of 3 2/4/2011 Continued

i 1
Faciii Number: Zk - 1 Ll jDateof Inspection:_ ,3 7/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zio
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 64A ❑ NE
Structure 6
❑ Yes �No[:] ❑ NE
❑ Yes B No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
E] NA E] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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): Q�pRuY. ofh 1kA.t P_aZt R,
13. Soil Type(s): \A n
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 [� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes [+ No ❑ NA E] NE
❑ Yes [E/No ❑ NA [] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [J(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [1(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 Ea"'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 [dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑No ff NA ❑ NE
Page 2 of 3 2/412011 Continued

Facili Number: a - y Date of Inspection:__.* I p 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!3"No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ERIN'o
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 Cg4o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ❑ No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [S�No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes Ef-No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments (refer to question #)-.Explain any YES answers and/or any -additional recommendationsor any other commenti.,°=
� 4
Use drawings of facility to better explain situations{use additional pages as necessary}.
❑ NA ❑ NE
[:INA ❑NE
❑ NA ❑ NE
❑ NA E24NE
[]Yes [gNo ❑ NA ❑ NE
❑ Yes E2(No ❑ NA ❑ NE
❑ Yes [9/No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: CM 1301 2LV_�
Date: 51631
d�
2/4170;1

I ype of visit: Q�Morn Hance Inspection U Operation Review V Structure Evaluation O 'technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: , County: Region: 10=40
-� fin.
Farm Name:71m�v\'
4t c_ r--. Owner Email:
Owner Name: 1 g /UL , Phone:
Mailing Address:
Physical Address:
Facility Contact: at ` is � r(,�j EC-'_ Title: _ls2 Phone:
Onsite Representative: Integrator: A—K:�
Certified Operator: �L(r � ��r cx �s Certification Number: cI 35991?
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?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes " No ❑ NA ❑ NE
[:]Yes
❑No
2-�A
❑ NE
[:]Yes
❑No
UJINA
Designer Current Design Currents
Design Current
Swine
Capac�tS ;`Pop
Wet Poultry
Capacifv „ I'op
Cattle Capacity Pap.
Wean to Finish
[Layer
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish'-
�,
Dai Heifer
Farrow to Wean
amu_
Design Currents
Cow
Farrow to Feeder
D , P�nul
Ca aci „Po��`:°
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
-. Turkeys
Other
���.� ,,,;�� ��-
TurkeyPoults
Other
Other
_
Discharges and Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes " No ❑ NA ❑ NE
[:]Yes
❑No
2-�A
❑ NE
[:]Yes
❑No
UJINA
❑ NE
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
0 No
014A.
❑ NE
[:]Yes
[Y] No
❑ NA
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
Page I of 3 214/2011 Continued

Facili Number: - Date of ins ection:
Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
<o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D No
[B<A
❑ 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
EP -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
[9<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
[B&
❑ NA
D NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g'lqo
❑ 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
2r<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[✓fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ fVo ❑ 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 Iof�+Wind Drift\7---s [] Alication Outside of Approved Area
(�
12. Crop Type(s): Q g`I lht.i r�CA� �1"nL14 (q'Y?9 '4 b &D
13. Soil Type(s): _V
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eg<o ❑ 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 [9] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 D Lease Agreements
❑ Yes [g No
❑ Yes []J40,
❑ Yes [LENo
❑ Yes [To
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [B% ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? [:)Yes io ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No EINA ❑ NE
Page 2 of 3 2/412011 Continued

]Facility Number: - Date
Fof Ins ection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] 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 19'l�o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA EId
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
El 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
MM
❑ 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
031ro
❑ 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
❑moo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9-M
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[gWo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CD -No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers-landlor. any additional recommendations or any othehc6inn eiits.
�,ec�.st� C t��ti � � -� wG�- � v►�--- �, r.�r-� ar-e-u- �-�I'� �
Reviewer/inspector Name:
Reviewer/Inspector
Page 3 of 3
1 to.
Y
Phone: 110
Date: Z
2/4 all

f
0.(IRS 05 111gt(0
Type of Visit �9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: ;4 Departure Time: County: J 119 C Region:
Farm Name: pr m,- FLIM Owner Email:
Owner Name: IX i� E Che>PS Phone:
Mailing Address:
Physical Address:
Facility Contact: Pi (, ht -rrt b—( Wads Title: 01ya 4- Phone No: Q1HRA � tT
Onsite Representative- Integrator:
R1 svr w r9 8-1 `i
Certified Operator: Operator Certification Number: 19121
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =, [=It Longitude: =0=f
o=f =
Discharges & Stream Impacts
_ is any discharge observed from any part of the operation?
❑ Yes E;�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
Design Current Design Current
Design Current
Swine
ion lation
Cattle Capacity Population
❑ No
❑ Wean to Finish
; ❑ Layer
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Dairy Cow
❑ No
❑ Wean to Feeder
❑ NE
JEJ Non -Layer I
I❑Dairy
Calf
afeeder to Finish
actn
❑ Dairy Heifer
❑ Farrow to Wean
Dty IPo�ttry
❑ Da Cow
❑ Farrow to Feeder
'4;� Yes
❑ Non -Dairy
El Farrow Farrow to Finish
❑
E] Beef Stocker
❑ Gilts
; ❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
El Turkeys
Other
❑Turkey Poults
❑ Other
❑ Other
Humber of Structures:
Discharges & Stream Impacts
_ is any discharge observed from any part of the operation?
❑ Yes E;�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'?
'4;� Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IR No
❑ NA
❑ NE
other than from a discharge?
12/28/04 Continued

Facility Number:,q; -,�' — jq3 Date of Inspection �� S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes E'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Use drawings of facility to better explain situations. {use additional page�sTas necels�sam
Spillway?:
aE� q 4101 q� O1C&or 3S. LQmj `u �?ic.}\ad lrgk(LS wo F-- 11410 , P11e6j2Suhiy, iIq
ht;l� 1 ki
ce
•
roc'eAfI L >��s no�-s U iMJ rComtopo rm,��
c}
Designed Freeboard (in):
34 �J&'C'q v* �-Pf Dix}eChv� r �'4LS.J.
tColf "+ abo�% n6t'o� oto coyr� Soi) �J hD�d �Lmo-,�e� ShDan ►�
Observed Freeboard (in):
Reviewer/Inspector Name �� C ; , 17 1, Phone��
Reviewer/Inspector Signature: Date: i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[5kNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
EjNo
❑ 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 enAron mental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
[9No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®'No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
qNo
❑ 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 [I Evidence of Wind Drift ElApplication Outside of
Area
12. Crop type(s) Cobfal P(r1jdtt%41_V0AUfe_ a j')1 lh 0Vv' V;P
13. Soil type(s) Rio n t ,j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA ❑ NE
17_ Does the facility lack adequate acreage for land application?
❑ Yes
&No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J'No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations ar sny other comments.
Use drawings of facility to better explain situations. {use additional page�sTas necels�sam
aE� q 4101 q� O1C&or 3S. LQmj `u �?ic.}\ad lrgk(LS wo F-- 11410 , P11e6j2Suhiy, iIq
ht;l� 1 ki
ce
•
roc'eAfI L >��s no�-s U iMJ rComtopo rm,��
34 �J&'C'q v* �-Pf Dix}eChv� r �'4LS.J.
tColf "+ abo�% n6t'o� oto coyr� Soi) �J hD�d �Lmo-,�e� ShDan ►�
Reviewer/Inspector Name �� C ; , 17 1, Phone��
Reviewer/Inspector Signature: Date: i
Page 2 of 3 ✓ 12/28/04 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I�R No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes F>_TNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
"® Waste Application ❑ Weekly Freeboard ❑ Waste Analysis lEgSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ 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?
ayes
❑ No
❑ NA
❑ NE
25. Did the facility fait to conduct a sludge survey as required by the permit?
❑ Yes
fgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus toss assessment (PLAT) certification?
❑ Yes
❑ No
ENA
❑ NE
Other Issues
C� 1'd�0_ �I'v6�SeaCads
10( C(�
C r. �r �;Cod 1r �y C-10&' ret �7PC1
Gail S tr i Ins r 1 , l'11a� ieG�►a sef O
U l� ,r war dl
�, �°�7ry A hs f
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
SNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
�o�ti'C•c� j � #rcr-h br�re he 1P�- (n! ci
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E9 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
RjNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
Ej Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
'9 No
❑ NA
❑ NE
Additional Comments and/or, Drawings:.. " i -
ar Q� Ci>"GInO�`�t��(76
to
IS I Jilt? 1 m ac i o Vvo() �J 0� 5 l , SCla
o
re j sCra in : Note- vYr-L-0)
��o
C� 1'd�0_ �I'v6�SeaCads
10( C(�
C r. �r �;Cod 1r �y C-10&' ret �7PC1
Gail S tr i Ins r 1 , l'11a� ieG�►a sef O
U l� ,r war dl
�, �°�7ry A hs f
a w���z �1te,'� o$t au#k Ivy Old tj , " .. i�x ►'+ lover
' �jn
Rea OC-i-hQAbr ��
caJ� reels b 6ld aty�e �M Co fI.brAn rye�w�
13"I1p bv'i-as
h i yam- r was v 3d Q, the
rz 00deo l409 (� �le-AV11It tele --10 l PS►�ry �oF a� 11 k,`I w►11�e�
n �
`eof a,, e" aft' ilk a .gym
(�. dW� 17ct .� I eaJ� br o(a a d ur j p_ �Y� d ' r I a a� d ` `itxrQs of
% ' i_r ct t y 14- i f �
� .�
�o�ti'C•c� j � #rcr-h br�re he 1P�- (n! ci
Page 3 o f :�u1' 1 i 1�' I5 Vi 3 v'10 A i -.SC f�; Cf Ski Yt *mf- d U eA0 � l�l}vf ] t $i3�

W
bq 6
Facility No. rfi��- ti- 'i, Farm Name PM �'h Date io
Permit COC �_ OIC_NPDES (Rainbreaker PLAT Annual Cert )
Pop. Design Current FB
Type Dro s
x
Lagoon 1 2 3 4 5 6 7
Spillway
Design freeboard 1
Observed freeboard in
Sludge Survey Date j
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume 01; S
.4o 1 Nebo, vrr'ZI„ i
CalibrationDate MUM
Design
Designlist
Soil Test Date _
pH Fields
Lime Needed
Lime Applied _
Cu -1 Zn -I
Needs P _
Crop Yield
N Amt (Ibil 000 Gal)
Wettable Acres
WUP �--
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes
Transfer Sheets
RA AUGE _ c�
ead b x or incinerator
o ality Records
PyMpd a)►a-dI&
Pull/Field Soil ctop Acres PAN Window Max Rate Max Amt
a
a
50
Verify PHONE NUMBERS and affiliations i f
Date last WUP FRO Date last WUP at farm � 10) (�
FRO or Farm Records
Lagoon #
Top Dike S�.p
Stop Pump
Start Pump
Conversion- Cu -1 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac
App. Hardware
Soil )4f6_6 01ftf4 010_
Die r (oIq)(0

c�-,10
goo �1�4h1-

t- s /z_z_z zooq
Type of Visit @'compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit:9 County: Region:
Z 0 Arrival Time: ; Q s Departure Time: Coun :O f,._. =�—
Farm Name: pr F::4 0''"- Owner Email:
Owner Name: b i x, .- e -A&P S , Z✓<� Phone:
Mailing Address:
Physical Address:
FacilityContact: Title: Phone No: !10.22 t. !t 9 Zr
Onsite Representative: Integrator: IW- 46k' -^Z
Certified Operator: Operator Certification Number: 190`%!
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 ` ❑" Longitude: = ° ❑ "
Design Current
DesigFCmrrent
Design Current
SFsitte Capacity Population
Wet Poultry Capaciulativu
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
Non -Layer
❑ Dairy Calf
® Feeder to Finish O 2
IIIQ
❑ Dairy Heifer
El Yes
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
El Beef Stocker
❑ Farrow to Finish
El Gifts
Non -Layers
❑ Pullets
❑ Turkeys
❑Beef Feeder
❑ Beef Brood Cow
❑ Boars
Other
❑ Other
❑ Turkey Pouits
❑Other
Number of Structures:
�,/
NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
❑ No
��
ETNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[j Yes
[j No
LINA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (I f yes, notify DWQ)
❑ yes
1:1L7 No
�,/
NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
B 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?
12/28/04
Continued

11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
LTNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Facility Number: — Date of Inspection
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) - - Re- l d, s -
Waste Collection & Treatment
4. Is
13. Soil type(s)jo�
,��,,//
14. Do the receiving crops differ from those designated in the CAW MP? [__1 Yes
storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
L_7No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
21q -o
❑ NA EINE
Structure i Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: Z`
�t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S—leo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
0.5
❑ 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
ErNo
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
B';lo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
[2-
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�,�
Lf O
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
LTNo ❑ 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) - - Re- l d, s -
13. Soil type(s)jo�
14. Do the receiving crops differ from those designated in the CAW MP? [__1 Yes
,,�__,,//
I �No ElNA [3NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
O NNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
E] No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
L No ❑ NA ❑ NE
Comments (refer�to question#) # ExglamyYESranswers'and/or any recoimmendatioas or any other comments
[ase dravnngs of facility 6'b atter e>gSlau"Ssitaiatians: (use additional pages asrnecesMAN F9
sary):
Reviewer/Inspector Name ��r" ler.✓Glj Phone: J/O. f�3• X300
Reviewer/Inspector Signature: Date: 12 - / K--2001__
12/28/04 Continued

Facility Number: 72 —/4L3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 911o_ ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I3 <o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather Weather Code
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C4<o
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA-
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I,J Noo
❑ NA
❑ NE
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2 o
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L1.�,<
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1�+Hloo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,L.�,,'N�o
L"I'No
r
❑ NA
❑ NE
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IYNo
❑ NA ❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C4<o
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B-9.
❑ 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
2 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
E❑, o
El NA El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
I_aNlo_ ❑ NA ❑ NE
Comments and/or Drawings:
12./28/04

0 Division of Water Quality
Faeility Number a 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 40 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 3 ; Departure Time: County: P Region:
Farm Name: C� 4 12 �-r�acon Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: VmnyA DQ*C) 'fTitle:
It
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
6
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e 0 0 u Longitude: =°=I =
W
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEy Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:©I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes IM No ❑ NA ❑ NE
❑ Yes
❑ No
)91 NA
❑ NE
❑ Yes
❑ No
V9 NA
❑ NE
F1 NA
❑ NE
❑ Yes
❑ No
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
12/28/04 Continued

J
Facility 1Vumber:
Date of Inspection Eppid
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier: 1
❑ Yes P No
❑ Yes ❑ No
Structure 5
C-1 NA EINE
RNA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
It
Observed Freeboard (in): aq
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[j9 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
[9No
❑ 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
QU No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P 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
W No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W 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) CAZ-W &fVylucla ) sw• . r, ��d - _
13. Soil type(s) 5$
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 93 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No ❑ NA ❑ NE
No ❑ NA ❑ NE
No 0 N El NE
] No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any.recommendatyons or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary): � ro
Reviewer/Inspector Name
Phone:
-3360
Reviewer/Inspector Signature: Date: !//��(�
Page 2 of 3 12/28/04 Continued

Facility Number: f 3 Date of Inspection 1 30
Reg -Wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Callo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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
n No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
El Yes
LpNo
❑ NA
❑ NE
❑ Yes
qNo
❑ NA
❑ NE
❑ Yes
�No
El NA
El NE
❑ Yes
`P No
❑ NA
❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes EpNo ❑ NA ❑ NE
❑ Yes J' No [:INA ❑ NE
Additional Comments and/or Drawings:_,
T
Page 3 of 3 12/28/04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit * Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S- (1 Arrival Time: I:00 Departure Time: County: � +j4Uon Region: Fi O
Farm Name: C a.,, D �a�� _ __ Owner Email:
Owner Name: _ iVe,7A EA_ /Ile1a.•,6 Phone: 9/0 -'SEW.- 15-1&
Mailing Address: !1&2
C- /e C /1 �14rf NC -:2 93-:2 5
Physical Address:
Facility Contact: 7,.�,e.� /tIc/a...6. Dea, Me" Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No: 9/0- cfgo-15176&
Integrator: _/hy4024y_&42 U64
Operator Certification Number: !909/
Back-up Certification Number:
Location of Farm: Latitude: [� 0 0 , 0 „ Longitude: E] o 0
Swine .
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder j ❑ Non -Laver El DaiCalf :
51,Veeder to Finish o 1.2 170
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑.Gilts
❑ Boars
Other
❑ Other
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?
❑ Dairy Heife3
❑ Da Cow
i
❑ Non -Dairy
❑ Beef Stocker
I
❑ Beef Feeder
JLJ Beef Brood Cowl _ 1 1
Number of Structures:
b. Did the discharge reach waters of the State? (ll'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 04o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:1 Yes
0,fo
[:1 NA
El NE
❑ Yes
DN—o
❑ NA
❑ NE
12/28/04 Continued

Facility Number:a — / 3 Date of Inspection
Waste Collection & Treatment ��.,,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L�'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: It0
Designed Freeboard (in):
Observed Freeboard (in):r`3 ^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D -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 Eq,<o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [ es ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[Jf4o
❑ 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
[lflo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
,,�—,,II
El'wo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
,�l1
L 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 Drifl ❑ Application Outside of Area
['7O/ g -p
12. Crop type(s) _ a !'filec�- S.., ff
13. Soil type(s) A06
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�v0
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
E14o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
❑ No
❑ NA O'FIE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA [2'KiE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ �No
❑ NA ❑ NE
X1;7 please r / ar+..nd
I 5 l ova wo-c y 5 ctp/"a S Frbrn 105--1 41al�5. Please wart( an Aore artaS UL 105,&,1
fe psrixb�is4 rXa�•t� dtGsS CaVrr '4, loreve,7 2�OS.rr,
Reviewer/Inspector Name- �O L Phone: r1/U• 41-7r,'Y/
^�� �r.Gr,f�P.r ctr. _
Reviewer/Inspector Signature: Date: 4q-- 11 L04�'
12128104 Continued

. t
Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Uglo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check D-'Qes ❑ No ❑ NA ❑ NE
the appropirate box. ❑�❑ Ch fists E?6esign ❑ � ❑ O r
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O Xo ❑ NA ❑ NE
❑ ❑ Waelfip-FrecbetsY d ❑his ❑ W&*e-�rs a ton
❑� ❑`S1oCkii�$ �ek} ❑UQ NfiWgr❑ ❑ yylgatl]eC�nde
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 app l cafon 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
[-io
❑ NA
❑ NE
❑ Yes
K�No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
❑ Yes
El[ o
❑ NA
❑ NE
[:1 Yes
Ra o
El NA
❑NE
❑ Yes
E�<o
❑ NA
❑ NE
❑ Yes
9-1C o
❑ NA
❑ NE
❑ Yes
B to
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
EINE
❑Yes
jJNVo
❑N
El NE
❑ Yes
❑ No
❑ NA
❑ NE
Addifioaal Comments and/or Drawmgs:
_
K
`r7 odd I /PQse 1410G e a
Clnc� MQr;/ Go�o�
C olal o F �Lic /cr9cv:t al�s.g n •,
io the F6trrylev,Ae %% G✓u OTl�'rr
Fa��l leto�t�S
4/r'7�}rry 3 041y
12/28/04

Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: `�' Time: : ?
Facility Number $ � 1 y 3
O Not rational O Below Threshold
0 Permitted © Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ... .. _. _.
Farm Name: _ . _ c_ ... ........__.__,------ County: FRO
Owner Name: G 6 C� _... ........... Phone No:........ /o g`..
Mailing Address: _.. 33
Facility Contact:.......
ontact•.T / C L 6 ._ Title:Phone No: ,,,_ ��?' S te / �►
Onsite Representative:. �_..._.__ C'1 L u +,fir Iintegrator: _ � -__ ------ . _ � M�r�t�
— . �._
Certified Operator• 2 � /nG,� �7 Operator Certification Number-..—..-/
Location of Farm: 1
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �" Longitude �• �' �'�
Discharees A Stream I-mpact5
1. Is any discharge observed from any part of the operation? ❑ Yes 0Wo_
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes B ]leo
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 gal/min?
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: . _. _.._....... _. _.._ ...... .......
li
Freeboard (inches): i{
❑ Yes �o
❑ Yes [}lam
❑ Yes �0
❑ Yes ETIo
-/
❑ Yes QN0_
Structure G
12112103 Continued

Facility Number: ka — fy Date of Inspection oy
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes B-90—
seepage,
alioseepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes 0 No`
closure plan?
(if any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes G -No -
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ON—o'
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes O N&
elevation markings?
Waste ADDlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes [a -No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes LI-No—
[3 Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
/n�
/`% o ry
12. Crop type Ae01on "d-1 S�rae.4ra:w dvi.-00 l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Pigb
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [}V6
❑ Yes 9 -No
❑ Yes Eallo
❑ Yes ❑ No
❑ Yes [g -No
❑ Yes ❑ No
❑ Yes [RNo
❑ Yes [[allo
❑ Yes GjNo
CamuQeents (refer to ^gnestton) Explaut,a�ny xYFS answers and/or any _recommendations or any nater conui�ents.' y..
Use drawings of facility to Better explain sitaabans. (�se:addttioaat pages as necessary) '1 Q-Beld Copy ❑ Final Notes
- .
A,
I
F ease
rtpa:r Grvi:h urtrs 41(lvhri fayoor,,
10 Ire, 5e goy Gruv�c� lu of t3ort,
14/0 1 ,1 G+, ><<i 6 r e5 o v uv, fo "J"O
p ra vQ +�. t Sip t by it+'G U5,
Reviewer/Inspector Name-
Reviewer/Inspector Signature: B Date: 1-3- o `j
12112/03 Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the f ility fail to have all components of the Certified Animal Waste Management Plan readily available?
cls= sts, d , etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ ea- p eace-- ❑ Analysk ❑ Soil'Sampling—
w- y-/G3.o
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss reviewhmspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP 7
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3 L If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ S. I F ❑m Yield ❑Rainfall ❑
❑ p on
❑ Yes B -No
❑ Yes 9I00
❑ Yes [9 No
[] Yes p -No
❑ Yes QINQ-
❑ Yes Swo
❑ Yes UNo
❑ Yes ❑ No
❑ Yes ❑ No
9'fes
❑ No
❑ Yes
a o
❑ Yes
O -No
❑ Yes
l{10 Sal/ sea -"lo s c� �ul� v. � /°L.�T Sar.. /.S -�or
❑ Yes
,ONO O
-No
❑ Yes
Ohio
© No violations or deficiencies were noted daring this visit. You wiR receive no farther correspondence about this visit.
C.auaadlor-Drmgs LME�EN '-
r—AP-223
AL
l{10 Sal/ sea -"lo s c� �ul� v. � /°L.�T Sar.. /.S -�or
0vrq�e) MMc/u,n6 e ✓us e S[�,ryo/rs puri v r+
�o6L40h s uFfc r :nspe�/:ons af��r 1 ra,'h.
I2/I2/03

t r.
❑ Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
10 Routine O Complaint O Follow -uta of D\VO inspection O Follow-up of DSWCreview O Other l
Date of Inspection /vtp fl'7
Facility Number
Time of Inspection 24 hr. (hh:mm)
Registered © Certified © Applied for Permit © Permitted 113 Not Operational Date Last Operated:
Farm Name:.........f ........ County: sema.........................................
,......................
Owner Name:...... '�...: ,1�-:.0 p .tb� r -t4 �'!.�!.'.e�Phone No:..L..glt�...............................................................y�
Facility Contact: ....."^........ �l C.......... Title: ........................... Phone No: .................
..........
Mailing Address: . /. T . � .� C�.o� �+!'.IP..I- .................. ..........................
....................................... ............1� ,�......................
Onsite Representative:....-...., -rte Integrator:.... '!�`....��... ::�...........
c
Certified Operator,------....-_�yJ ... Operator Certification Number;-.
Location of Farm: Az" 7l,/.C,/ -A e;,,_ 4- /1. -'L_LLe �r�--
........................................•-••----------------------•-----, -
Latitude 0.0' _ ' Longitude �• �� �"
m Current y Y Des Curceut
Design urrent ign
Swine, a Capacity Popsuilation Poultry C;�aPacttY Populatton � Cat#le ; Capar�ty Pgpulatioa
❑ Yes
a _ N? ,
xm❑ Wean to Feeder
KNo
❑ Yes
❑ La
❑ Yes
❑ Dai
❑ Yes
5a -No
Continued
k:.
y er
D
Feeder to Finish &O
b
' ❑ Non Layer ❑Non Dairy
<, r..: ,mak ,,a �: V�,,. � s
'��
❑Farrow to Wean
❑Other �� � �-''�, �` ���% ;� ,k '`�
❑ arrow to Feeder
f,,
«essµ
Farrow to Finish
r
,,� x Total Des><gn Capac�tyy � * z
O'Silts
3
,r TotaI:SSLW:
A ❑ Boars
T 3C� ;g '
Numll�er of I.agooxis ! Hfliding Ponds;;:
> ❑ Subsurface Drains Present ❑ Lagoon Area
I [] Spray Field Area ,
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7- Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 13 No
❑ Yes 19XNo
❑ Yes ,[ No
❑ Yes $I No
❑ Yes
-OTNo
❑ Yes
10 No
❑ Yes
KNo
❑ Yes
No
❑ Yes
No
❑ Yes
5a -No
Continued
on back

Facility Number: —/V.?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons,Holding Ponds, Flush Pits, etc.)
9_ is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3 Structure 4
❑ Yes UNo
Q'Yes ❑ No
Structure 5 Structure 6
Identifier:
Freeboard (ft): ....�il.�.4..�:..9,.
10. Is seepage observed from any of the structures? ❑ Yes Nf No
I I. is erosion, or any other threats to the integrity of any of the structures observed? mYes ❑ No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............................
_....................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste -Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Y`Yes ❑ No
❑ Yes ;WNo
❑ Yes RgNo
❑ Yes
XNo
❑Yes
❑ No C.
Yes
❑ No
❑ Yes
WNo
❑ Yes
CkNo
❑ Yes
allo
WrYes
PW
❑ No
0. No:violations-or deficiencies were, noted -during this:visit.: Yo'U'W_iH reeeive•no-ftirtlier.::
i'6rri 06ndekC aWitt this:visit:.. • .:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
S.dE..:C'3:h�9'aF",. Y4r.. Yti S" `:, F : �. __ p.kl} 5s'x' '3 f rdi �+ "`YL"7Ye 9'^e9
Co nrrtearts (refer to questton #j Eatpl in any YES,ainswers and%r ariy reCo endsfions oir any outer c mmee
'
.`.
Use drawl s of,factlrty to better expiam situations (use add�honal pages as necessary} t r a '
#ca.,�'4"6'x.aL?Y�se<,.<
F.
10
/9
Reviewer/Inspector Name I
Reviewer/Inspector Signature: Date: /a ���"%

State of North Carolina
Department of Environment,
XT
F Health and Natural Resources 4 •
Fayetteville Regional Office
. - 21
James B. Hunt, Jr., Governor 2- M
p FE N r 1
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 8, 1994
Mr. Dino McClamb
C & D Farm
1234-A Sunset Avenue
Clinton, NC 28328
SUBJECT: Compliance Inspection
Confined Animal Feedlot Operation
Sampson County
Dear Mr. McClamb-
On October 28, 1994, an inspection of your animal operation was performed
by the Fayetteville Regional Office (FRO). Please find enclosed a copy of our
Compliance Inspection Report for your information. It is the opinion of this
office that this facility is in compliance with 15A NCAC 2H, Part .0217, and
that Animal Waste Management is being properly performed.
Should you have any questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
Michael D. Moody
Environmental Technician
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville, North Carolina 283011-5043 Telephone [phone] FAX 91D-48"707
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

i
NORTH CAROLINA DEPARTMENT OF , HEALTH & NATURAL RESOURCES
i yr • � • s ■• �� �:. yrs ,e�ei;, cr
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
C & D Farm, Mr. Dino McClamb f 10/28/94 1 N/A
1234-A Sunset Avenue
Clinton, NC 28328
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
Animal Operation Type:
Horses, cattle, swine, poultry, or sheep: SWINE
SECTION II
1. Does the number and type of animal meet or exceed
the (.0217) 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 REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12 -month period?
4. Does this facility have a CERTIFIED AN IAL
WASTE MANAGMENT PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
e■�
mom
lei

i
SECTION III
Field Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
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
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately 4 ft—)
8. Is the genetal condition of this CAFO facility,
including management and operation,
satisfactory?
SECTION IY
Comments
eek
II■
mom
aha
OEM
Section II (1): operation presently has 300 animals and plans to expand to
400 by January 1, 1995. The present lagoon capacity will allow for this
expansion.
Section III (4): Applies to coastal and rye fields. Although there is not a
certified plan, Mr. Bill Thompson (operator) is aware of the proper means to
dispose of waste and adheres to Best Management Practices.
Section III (5): Mr. Thompson maintains his records of waste management along
with other animal operation records. It was recommended that he begin to
maintain separate records on waste management.
Section III (8): Mr. Thompson is a very conscientious individual whose
operation exemplifies hard work and a vast knowledge of all areas of animal
feedlot operations.