820161_INSPECTIONS_20171231

NORTH CAROLINA
r.�
Department of Environmental Qual

1I
ivl-sion of Water Resources
M.FARE-111UNjumber ®- Division of Soil and Water Conservation
UE Other Agency
Type of Visit: om lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Icy, OArrival Time: ! 4 Departure Time: County: "f Region PC
r
Farm Name: _ 11+� - !.-� a`% 0'-- Owner Email:
Owner Name: kee kl Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: j
Back-up Operator:
Location of Farm:
Lp'P 1-''C/I le:
Latitude:
Phone:
Integrator: Ll�i2-- J
Certification Number: /qo t-
Certification Number:
Longitude:
Design; Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Catfile Capacity Pap.
Finish
La er
Dai Cow
Feeder
1
J
Non -La er
airy Calf
o Finish
(�
Dai Heifer
o Wean
Design
Current
D Caw
to Feeder
Dr, 1?oult ,
Ca aei
Po
Non -Dairy
EFarrow
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Poults
OtherINS
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 � ❑NA ❑NE
❑ Yes ❑ No
[—]Yes []No
[:]Yes ❑ No
❑ Yes [3-No
❑ Yes �No
ED-N-A ❑ NE
D-NA ❑ NE
E�'NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
Page l of 3 21412015 Continued

Facili Number: - jbf I Date of Inspection:- V­-
Wiste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3-Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [],Pima❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [I -No— ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
`P ""
❑ 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
[�-Nb
❑ 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
Q-IVo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E "o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑'IVo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C L'-�'
13. Soil Type(s): /VV b.V
14. Do the receiving crops differ from those designated in V6 CAWMP?
❑ Yes
[]'lo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail'to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[31�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej>o
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[Dlo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[21�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 [gKo
❑ 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 E3'1�0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: / j Date of Inspection: Q2'�ti
24.'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [j;•Moo ❑ NA ❑ NE
41
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (!]'go- ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
[I -No
❑ NA
❑ NE
❑ Yes
[D-lQo
❑ NA
[] NE
❑ Yes
0,No
❑ NA
❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes []-No- [] NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? [] Yes
c.(,(( CI o -
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
�&S[
ElMo
❑ NA
[] NE
[]..44V
❑ N A
❑ NE
Fq'I'To-
❑ NA
❑ NE
0-15o­
❑ NA
❑ NE
3 � A. 7' Phone
re:ODate: Ol �([v� {
21412015

iHj �llE� M1 9-5D,ivision of Water Resources::
Facility Number PD�'ivisiioi of Soil and Water Gnnservation
I
;,i mn� �.
QOtherAgeocy�
j
rype of visit: G-Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Q1111outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: { Arrival Time: Departure Time: County: sal I Region: rr-"7
� Farm Name: UtC C /D� Owner Email: r
r
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: i ( Title:
Onsite Representative: f C
Integrator:
Phone:
M (� s
Certified Operator: (� Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
t
owt1C
l'•t' I
I�u�
Resign
N,1IIHNN4.'
lil:lapuaun
��14�i9�H
.Current€'
"hdi1N�j
rnPdl°
I?p!
sti�kl `�lllil�i�q
'� „ ��„ Design�Cnrrent
N IhklliNd'us. wryNFlly°
Wet Plouml�GAy I�Nimialpl�Hi3Ailhyl�VisPS3°<'�.
Layer[Dairy
l
,:
��
lCiife . ! .rkfn
Cow
��I . I
Design Current
NNHNfifl m IM 111r.I INJ
pNaiPS14p'
i
Wean to Finish
Wean to Feeder
Cb
of
Ilf
Non -Layer
I'' i:ij
Design Gurreint
it "n'i '96it m tit 10,*Pj
D lPoult`: Ca acti'o :�
Dairy Calf
Dairy Heifer
Feeder to Finish
-ItOO
4 act
I
Farrow to Wean
D Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
jBeef Brood Cow
Other, „k;l
'
I. }
Turkeys
Turkey Poults
"Ir
N
Other
Other
:1Ylf£W.n
IrrlMnMl.Iwnllsllll:l6uUMAnnwnbu,iAu,tln Nrt MftWlnxvuAuti:Al,r1111n IIhMllnlnllrHiw�
I�<Mnrtnl�l.11iln3t nxMnlrml
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
❑-1 m
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[.}-tl-A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
0 A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑'lqo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: r - Date of Inspection:
Waste Collection & Treatment
4. rs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑.No [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [g-PA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 d 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]-No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[B'gJo
❑ 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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D.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
FlKo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D-T-o
❑ NA
❑ NI?
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑< [:} NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
i2.Crop Type(s): t1 � ,0UC-.
13. Soil Type(s): NO Ci c//oy
14. Do the receiving crops differ from those designated in the C WMP?
❑ Yes
Q-Ko'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F91�0
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q o
❑ NA
❑ NE
I8. Is there a lack of properly operating waste application equipment?
❑ Yes
Ea>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
D Yes
El"No
❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yes
Q-No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E3 o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainhreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility, Number: Date of Inspection: (0
24.,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �b ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes QfiTo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e.,'discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
�Y' Woe, 2
❑ Yes [3-Ko ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
[:]Yes E-Ko ❑ NA ❑ NE
❑ Yes F"o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes �o
❑ Yes [D-];to
❑ Yes Iq"'o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
cx[C-- 1(D - 30E- 6 �v
Reviewer/Inspector Name: 1J I l�0 Phone: T033�
Reviewer/Inspector Signature: RilDate: it 4w,
.1
Page 3 of 3 2/4 #15

Structure Evaluation Inspection
Facility Number: -- Date: a 1 4 �,ED
l
Time in: h t ZO Time out: , No it) / �,C
Farm Name: �r¢�i ,.� Let- Farm Farm 911 address: ' �c7� S`/
Owner Name:
Facility Contact: 14
Onsite Representative: PI Integrator: 14(,T
Certified Operator: Cert. Number
Is storage capacity less than adequate? Yes No -
If yes is waste level into the structural freeboard? Yes No
Structure: 1 2 3 4
Identifier:
Spillway?
5 5
Designed Freeboard (in.):
Observed Freeboard (in.): �L
Are there any immediate threats to the integrity of any of the structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes _ No tef*'
Does any part of the waste management system need repair Yes No
Condition of field's _ )! f
Condition of receiving crop 61Oy (' efn 142 f 521
Comments:

T%
Dlvision of Water Quality
' Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
type of Visit: �om�liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: C"j Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1� �p /J� Departure Time: _ �✓� / �7tj County: B
1
Farm Name;; � rn�'C ��r Owner Email:
—�R
Owner Name: 4( Phone;
Mailing Address:
Physical Address:
Facility Contact: T11" V In k.
Onsite Representative:
Certified Operator:
Region:
l
a!1fYtf:' Phone:
�i Integrator:
Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 3 30J o
Feeder to Finish '
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Non -La
Pullets
Other
Poults
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 7o ❑ NA ❑ NE
❑ Yes
[]No
[ A
❑ NE
[] Yes
❑ No
[ErNA
❑ NE
❑ Yes
❑ No
[31A
❑ NE
❑ Yes
❑1_o
❑ NA
❑ NE
❑ Yes
[fNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: -7,71 Date of inspection: jLEe
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MO ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No h1A ❑ 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 [Klo ❑ 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 [2,1qo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of /W�iind Drift ❑ Applicatioh Outside of Approved Area
12. Crop Type(s); C� "4- (:y''�� Gv
13, Soil Type(s): -- Al o a L c/
14. Do the receiving crops differ from those designated in tha CAWMP?
❑ Yes
[2-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
Q o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �ro ❑ 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 �No [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3 1gIo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[�IO
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
ZoNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[5'1�o
❑ NA' ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3lo
r] 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
[Z�No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[2'Iio
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[;�`No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[yNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo
❑ NA ❑ NE
IComments (refer, to question;#) Eaiplain any'YES an"swcrs'and/or any additional: recommendations or anylother comments:'''
U.sedrawingkof facllity;;to heifer.ez'pinin ltputi�ns,;(use additional pages;asmecesserv).
-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
10 - �_ I q
— + .? - d � • E-7 �e r 2 of e ' 4 «11C7
Phone: 43
Date: i_—S-4 �6
21412011

Type of visit: 0,Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (8'iioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: rrival Time: r Departure Time: County: s4!�d. Region:
Farm Name: y-` �,� s f Q0 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 0'^ Title:
t
Onsite Representative:
Integrator:
Phone:
l
Certified Operator: it i Certification Numlier:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
rJklilaw''M
Design
Current
Design
Current
Design Current
Swine
Capacity
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capsacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
p
I INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Deslgn
Current
Dry Cow
Farrow to Feeder
De, 1',aultr.
Ca aci
P.o P.
Non -Dairy
Farrow to Finish
Layers
I
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? [:]Yes [I-N—o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes ❑ No dNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[f 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 DWR)
❑ Yes
[:]No
[;�<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
E!rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EJ'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

incility Number: - Date of Ins ection:
WasWCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No J3'IqA ❑ 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
[?L,3a
❑ 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
CZL>a
❑ 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
[tJ A
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L7 '"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
[ai-Ko'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [31-11757- ❑ 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): WS lo C-7-1_- •t
13. Soil Type(s): p to co o ;/
14. Do the receiving crops differ from those designate in the CAWMP?
❑ Yes
21'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ef'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FoT%
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
hIo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L to
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
`-;, -
❑ 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 l.Cl 0
❑ 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 21 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412014 Continued

Facility Number: - 7, Date of Ins ection:
24. Did'the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
GE�Ne ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
I T 1" 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
[B'No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q,.W f ❑ NA
❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
��
❑ Yes [] 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 ❑'IQo ❑ 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 ON ❑ 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 <o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
ElYes c No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No ❑ NA ❑ NE
Comments re q y. additional recommendations Y
(referto question y,: ran t► er comments.
Use :drawings of facility ;to:;better ex lain situations use additional ` h )• ..
p ( a es as necessa
, '
f
' r I
�- - 3-1
P. y.6 I
Reviewer/inspector Name: Phone: `j<� <1 % y
ReviewerlInspector Signature: Date:
Page 3 of 3 2/4/2 14

L
peof Visit: (&M Hance Inspection V Operation Review U Structure Evaluation (� Technical Assistance
ason for Visit: (Routine O Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 4. 61Arrival TPv&—
Departure Time: County:
Farm Name: fi L'r Owner Email:
Owner Name: 1 ( Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
00title:
Region:
Phone:
Integrator: fk45
Certification Number: l O S
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Currcnt Design Current
Swine Gapaclty Pop. Wet Poultry Gapacity Pop. Cattle
Design Current
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
D . !P-oultr. P
I
Dairy Calf
Feeder to Finish
v —
Design Current^i
Ca acity. . Po` P.
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy --
Farrow to Finish
Layers
Be Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Ocher
Other
Discharges -__and Stream Impacts
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 [3`1 iTAA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [D-h C ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [-]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ N�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ®No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility.Number: Date of Inspection;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [] No 2-KA ❑ NE
Structure 5 Structure 6
❑ Yes E2114o ❑ NA ❑ NE
❑ Yes [ <o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Vo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 02<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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Aauiication
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 Q No ❑ NA ❑ NE
[] Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 1bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 1 n , G �_ . `tr!
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes ❑'Flo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes [�lo ❑ 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 [:]Lease Agreements
❑ Yes QCio ❑ NA ❑ NE
❑ Yes [2No [] NA ❑ NE
❑ Yes 0 o ❑ NA ❑ NE
❑ Yes C3 N ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes ENo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

f
Facility Number: - Date of Inspection: gamb
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�' oo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EKo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes io ❑ 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?
7— f .�
4
Reviewer/Inspector Name:
" /j/� I
Reviewer/Inspector Signature: �` / /
❑ Yes E3<o ❑ NA ❑ NE
❑ Yes g< [`] NA ❑ NE
❑ Yes [:Ko ❑ NA ❑ NE
❑ Yes
04
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
[:]Yes
0No
❑ NA
❑ NE
[:]Yes
q4o
❑ NA
❑ NE
/f
Phone: ilo— �J""333
Date: Re 06 !
Page 3 of 3 21412014

2;;�2 /t, 0 U
rzn ivision of Water Quality
Facility Number - O Division of Soil and Water Conservation
O Other Agency ==1
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
rrival Time:
Departure Time: f County:
Farm Name:
wv, L
rag-
Lf, I Av-
Owner Email:
Owner Name:
it
Phone:
Mailing Address:
Physical Address:
Facility Contact:
c
Onsite Representative: (/
Certified Operator: �(
✓^ Title:
Region/2�_10
Phone:
Integrator: Y-L A5
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
3 � U
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder.
Farrow to Finish
Gilts
Boars
Other
Other
Laver I I �::�]
on -Layer
Design Current
Dry Poultry Capacity POT).
Layers
Non -Layers
Pullets
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)?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Daily
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes l "J' "'o ❑ NA ❑ NE
❑ Yes
❑ No
D4A
❑ NE
❑ Yes
❑ No
[! NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No R�A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes r10 [DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CTNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - rD­ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Rof�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ TNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Mllqo
❑ 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
C No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
[�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
QAo
❑ 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
Z]Xo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E�<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Qo ❑ 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 ❑Ap�plication Outside Approved Area
12. Crop Type(s): �1 bea v C
I . r'CSC I, `e �7 V
I - -1 -
13. Soil Type(s): - — .. 0_, LA. -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Rio
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EJ-90
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[Dl<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZVo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑moo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:�INo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ffNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []. No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1 :r14 b nN 1 92 - 1 C7
Facili Number: - U2 JDate of Ins ection;
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g]�No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes E3,140
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 [B N,o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3'I io
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 bsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name: '
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [ o ❑ NA 0 NE
❑ Yes [S'1Go ❑ NA ❑ NE
❑ Yes [3Xo ❑ NA ❑ NE
P'Yes Coko ❑ NA 0 NE
❑ Yes Eg'<o
❑ Yes [g'No
[:]Yes F41�0
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
'433- 333
Date: A AV
21412011

�la31 I �
Facility Number ®-
("ivislon of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1(T A Departure Time: F071W County:ZPc�
Farm Name: q u k� i? R L-ie Y. TA AV `rat Owner Email:
Owner Name: _ PA L%;mNr o__ �-A kok Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: ql QR kt \ t 0, J'kA!�I je)R Title: Q Phone:
Onsite Representative: nn 5rA(yL Integrator: U�DIn�t f�CSUjn]
Certified Operator: 1A Vi�� .{Z �!kN 1J & Certification Number:
Back-up Operator:
Location of Farm:
Swine
Certification Number:
Latitude:
1oV
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
'jaC]p Nan -La er
Wean to Finish
Wean to Feeder
13
Other
Other
Pullets
Turkeys
—.Turkey Poults
Other
Design Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
rCrNA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
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
❑ No
[E�NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
CE(No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number; % Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E2(NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c�l1a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[JNo
❑ 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
[v]'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[gNo
❑ 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): CbRt�1ti--1_JI�>:fa�� KSI N�£IZ 0 Muk.. fuy'-Up- C-N(LA2.r,
13. Soil Type(s): [,�y d Gsa R l L
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes leNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [gfo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CE(No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3'�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ 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
YNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2*No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
X NA
❑ NE
Page 2 of 3
21412011 Continued

Facilit Number: V, a, - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Z`No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No eNA ❑ 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 YNo ❑ NA ❑ NE
❑ Yes [30No ❑ NA ❑ NE
❑ Yes E'No ❑ NA ❑ NE
❑ Yes CglNo ❑ NA ❑ NE
❑ Yes
dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional Daees as necessarv). 4
* '21.�c�oo+�ts SPA S1ua►g . Rt.rrout.fl sN QoMa- ack%k.. %�l-VL d�-
l%C zssu An E.��s�+nSzvn o� bc�t-� �.�Stx,,�5 Stiuo��� SviLVE�( un�zi
/­N,d \ a .
Gad)
� �A z�clz A�dn �'3�.�izs,i bosh
Reviewer/Inspector Name
Reviewer/inspector Signature
Page 3 of 3
1,013013H5 r,w� S°,� ve- z4 phut
' ` Cal
Phone: • ;� r
<� ea 'a. ,A� Date: B Lei I i
011

Type of Visit: aCompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: t$ Routine O Complaint O Follow-up O Referral Q Emergency 0 Other Q Denied Access
Date of visit: �1r- Arrival Time: Q;a7 Departure Time: County: SQ/h S
Farm Name: ��l LPf- 1V0ytor Owner Email:
Owner Name: hy/ V0 a' Phone:
Mailing Address:
Region:
Physical Address: aye Q kabh Iff Sf 0-1 Liodo
I
Facility Contact: 7` V/ pay �Q/' Title: Phone:
Onsite Representative: Vi Integrator: B
Certified Operator: Arhyr Nay I Qc Certification Number: 1%y8-
Back-up Operator: Certification Number:
Location of Harm:
Latitude:
Longitude:
sign C*urrcnCacity
tiPop.
Wet Poult=YC.'
cify
Pop,
C►attle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
airy Hcifer
Farrow to Wean
Design
Current_
Dry Cow
Farrow to Feeder
Dr, P■oultr,
Ca acit
Po P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharaes and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ 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 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
E] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
M No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes Callo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I
Identifier: WV___
Spillway?:
Structure 2 Structure 3
❑NA ❑NE
[DNA ❑ NE
Structure 4 Structure 5 Structure 6
Designed Freeboard (in): 1� 1 q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes [5� No [] NA M 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
5a No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
[] NA
❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [5 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
acres determination'?
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
U No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
15� No
❑ NA
❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
U No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�ANo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
[RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 tail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
O NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: $a. - b Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes N No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge'? ❑ Yes 15il No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 5�_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.
EjjApplication 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 [jR No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [�JNo ❑ NA ❑ NE
J'Ycs ❑ No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes [S No
[:]Yes Cg-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to questions#)Explain any, YES answers and/or,anyindditlostM recommendations ar g'ny;othcri'cotriM'.e.
Use drawings of facility to better explain.situations. (use udditianal pages as necessary).;
�,31,71
-it Ids- �;- alk )3 ,
a5t S I vlj e— 6a s v►<<� I be. c� lie In a D�a, �y t?�cflrl �� ,
r
Reviewer/Inspector Name: t�On schrreflor
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 433-33Cj 0-0c(e
Date: 4 al n
/4/2011

Facility Na.Farm me tee Date
Permit —L1----t✓OC� OIC- - NPDES (Rainbreaker PLAT Annual Cert )
Pop.
Type
Design
Current
FB
V,L�II'' "�n'i�r'"! "NIM
Lagoon
1
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge -Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
NORM •
,�I�-------
W-MV MET,
Soil Test Date Wettable Acres ✓ *ortality
GAUGE
pH Fields WUP �� b x or incinerator
Lime Needed Weekly Freeboard Records
Lime Applied 1 in Inspections ✓
Cu-I iG Zn-I ✓ 120 min Insp.
Needs P Weather Codes
rmn Yiplrl Transfer Sheets
�
'310A
01- 7 M,
RRi'E
M7 of
.� r.
.r r.
1 1
fiffi�
J ri'.�'
Pull/Field
M*=1111111111111111110
.-
..WITTIMME
.90 - tr;
��Kw
Iko IF
i r . L
•
,E 0 /lt -
M
i
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 111aa jqj Date last WUP at farm
FRO or Farm Records %qm
Lagoon # Q0(V }ulr p
Top Dike 3
Stop Pump -
Start Pump 5L1
Conversion- Cu-i 3000 `108 Ib/ac; Zn-1 3 00= 213 Ib/ac
App. Hardware

.9-rAfS 2-65 -Z010
Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: !17f'tDeparture Time: County: rFarmNamc Owner Email:
Owner Name: ,,�� F /✓lor Phone:
Mailing Address:
Region: ��
Physical Address:
Facility Contact: �Ct�'T'i.S •�Q t'+~!!c Title: _ �p�9 • �B�G+ Phone No: r
Onsite Representative: Integrator:
Certified Operator:
Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I Longitude: = ° =1 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3 O D ❑ Non -Layer
❑ Wean to Finish
121vean to Feeder
E-laeeder to Finish
ElFarrow to Wean
ElFarrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLayers
El Non- Layers
ElPullets
❑ Turkeys
El Turkey Poults
❑ Other v _ .___
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
❑ Dai Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E�Ell
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 ETNo ❑ NA ❑ NE
❑ Yes Cl No — lA El NE
ElYes ❑ No L7lvA [I NE
❑ Yes ❑ No fA ❑ NE
❑ Yes ' io❑ NA ❑ NE
D
❑Yes lgon❑NA ONE
12/2"4 Continued

Facility Number: 82— 14e / Date of Inspection 1 ZZ— IO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
3/No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
B< ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ��� /(*'V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z 7 Z f
5. Are there any immediate threats to the integrity of any of the structures observed`?
❑ Yes
E 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
❑'Na ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�,�
[ o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
.,_,�
LTNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
El-Ko' ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window,, ❑ Evidence of Wind Drift ElApplicationOutside of Area
12. Crop type(s) � c/�a,.. KAI — GaI1' �fyl� L cC0 I�/.S Gc%nh/w ltVA;udlT
51'e, e_ [_ C" -it
13. Soil type(s) NijE (!�-p ft , L a,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2 o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
3 o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[I NA
El NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
,�
L ❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�I<
[? o ❑ NA
❑ NE
AI
Reviewerllnspector Name '` " P
1 Phone:
910, ;�33. 33Q0
Reviewerllnspector Signature:
Date:
!fi/G O/VY l.11rillrlNCN

• Y
rFacility Number: K2 -/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to ❑ 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
❑ Yes[INo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9<
❑ NA
❑ NE
No
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ej
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
l� N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LV N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ERNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,��
L''SNo
❑ 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
CrNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewertinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2 o
❑ NA
❑ NE
12128104

r�.Lvus ► n- n 7� �.n o 9
[vision of.Water Quality
Facility Number Divisioniof-Soil and Water Conservation
Q Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: -%s_ Q19, Arrival Time: 2..TO Departure Time: 3+'/O County: Region:
Farm Name: Yiry L« /Yf6r!'�l Owner Email:
Owner Name: A-144*' Lamer /raPhone:
Mailing Address:
Physical Address: //�� /
Facility Contact: _ yl n4 s Arwl! Ic Title: 526C-1 Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 g = Longitude: 0 ° = ' 0 {'
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
3200 tiaa ❑ Non-Layet
❑
Wean to Finish
IR`Wcan
to Feeder
eeder to Finish
QOO d
'794/
❑
Farrow to Wean
❑
Farrow to Feeder
ElFarrow
to Finish
ElGilts
❑
Boars
Other
❑ Other
Dry Poultry
ElLayers
ElNon-Layers
ElPullets
ElTurkeys
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
El Dairy Calf
El Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
ElBeef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 3- ll�o ❑ NA ❑ NE
❑ Yes
❑ No
E '<A
❑ NE
❑ Yes
❑ No
M NA
❑ NE
G-m
❑ NE
❑ Yes
❑ No
❑ Yes
Flo
❑ NA
❑ NE
El Yes
9-Nt-❑NA
El NE
12128104 Continued

Facility Number: —!6/
Date of Inspection
Waste Collection Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJONo ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes 5o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Xy!.- �e�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E o ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes a< ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes ©'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�,
9. Does any part of the waste management system other than the waste structures require El Yes I�"Na El NA ❑ NE
maintenance or improvement?
Waste Application ,_ �
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes [31 o ❑ NA ❑ NE
maintenance/improvement? �,
11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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 Drift ❑ Application Outside of Area \\
12. Crop type(s) �r�1�t� t�. � `Say ea �v� , _jclien4*4NNua.1 . iZS-C& c- (G rrA c J
13. Soil type(s) Nb 6 _ goA La-
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
,_ ,/
L7 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
BN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Io
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ Noo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
011O
❑ NA
❑ NE
Reviewer/Ins ector Name
p ! C
,. rpif/
-�
S �.,� t ,i ,41
Q
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3
12128104 Continued

l .. ..
Facility Number: ,2 —/fQ/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I5 Na ❑ NA ❑ NE
the appropirate box. ❑ W`Up ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
DONo
❑ 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
0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EKo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E oo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[R o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[R<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
l3No
❑ NA
❑ NE
Other Issues ,.,
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2 o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ESNo
❑ 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?
El2 Yes
�
o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�
, _,No
l—�
❑ 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
2<o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
la<o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Z/JD S Arrival Time: /%7S Departure Time: 2: /S County: S�G'`e pse�/ Region:
Farm Name: _ 14-1Aa - 4e r- /O r Owner Email:
Owner Name: Ar-z4ar A v hk- Phone:
Mailing Address:
Physical Address: �r
Facility Contact: CUA5 3aeW)GK Title: SPe <'— Phone No:
Onsite Representative: ArAu e N!r glee F Cle S �� �"� G Integrator: CO A a Vii Aa yes
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o ❑ ' = Longitude: ❑ o = ' = "
Desi n Curre
g nt
ya,
w.�V
Design Curre
Itry
CapacityPulataI
II Capacity Population
❑ Wean to Finish
❑ La er
'" ❑ Dairy Cow
Wean to Feeder
3200
3147
❑Non -La er
' ❑ Dairy Calf
® Feeder to Finish
gol
$D
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑Beef Stocker
El Gilts
❑Non -La ers
El Beef Feeder
El Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
� ' j'°'�� "1 • I ��
Other
❑ Other
❑ Turkey Poults
IEJ Other'
Number.of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EKo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
e NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0 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
3A
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
iJN"o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElB Yes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0'5-o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A1u ' Ie-t-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S .S3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan'.?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Blro
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
B oo
❑ 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
0'1'q-o-
❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑-N-o—❑
NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
[]Yes
e'N-o-
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12, Crop type(s) Gpt-A/ Sn.,�i c[IV l�r n1 w�Qnuyla�_ r 5"Gu G
��rcT.�c�
13. Soil type(s) /l7n R GO g
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
3 ivo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
a<
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
G-go
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q-t�o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 14�'c.k GV IS Phone: [phone],333e9
Reviewer/inspector Signature: Date: Y-/Z - zoeg
1212 /U4 Continued

s , ..
Facility Number: $2—/(o / I Date of Inspection /�-
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes BINo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropirate box. WUp ❑ Checklists ❑ Design ❑Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes qo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O Ko
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0-5—o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Dglb
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[}1zo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Oho
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EMT
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0-Tqo-
❑ 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
EKo_
❑ 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
3-5oT
❑ 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
O'iro
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EJ-W
❑ NA
❑ NE
Additional Comments. and/or Drawings:
12128104

i
E,v�kr� d 9- Z8- 0 7
RR
x
I...
kacility Number g'Z O
t0
vtstn of Water Quality
vision' o€ Soi! .an ter Conservation
Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit & Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time: 'ss
Departure Time: County:
0-U4!L0%✓ Region:
Farm Name: A
u r,i /i/at,.1or
Owner Email:
Owner Name: _I.11
v ,<< < 1�1
Phone:
Mailing Address:
Physical Address: ��ff I
Facility Contact: 0444 at_- L ­0 _ Ala y 41 P— Title: Phone No:
A r44,A& t. y IS V
Onsite Representative: Q&e'7J� 3 gli�i StWiQL Integrator: s
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:
0
Operator Certification Number:
Back-up Certification Number:
❑" Longitude: 0'0' 0,
w
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
37 a h _ 13U2 1' ❑ Non -Lay -et
Other
❑ Other I
Dry Poultry
Non-L,
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design . Current
Cattle Capacity 'Population;;
'l
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any pail of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes "No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
( No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[P No
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
M
❑ ❑
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
NA NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
5 No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: � Jiiry
'�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (e 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ 1 No
❑ NA ❑ NE
(ict large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[� No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
VNo
❑ 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
['J1No
❑ NA El NE
maintenance or improvement?
WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
WNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
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
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Tz �0_ V 2L3 Phone: 919, Y33 , 33 d O
Reviewer/Inspector Signature: -jAz(�-- Date: 9 -Z7- ZD D7
I2128104 Continued

Facility Number: 2 — Date of Inspection 1-27-01
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes P No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ElYes ICE No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
( No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
La No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
lood No
[INA
[INE
Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®Routine- 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 2; / Departure Time: County: Region:
Farm Name: YYh p, Lee Owner Email:
Owner Name: A tr u yr Lee f.hlr Phone:
Mailing Address:
Physical Address:
Facility Contact: A1414I..-- ,L,e_,,. ��o.,,/nrr Title:
Onsite Representative: v Alallor
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: _ G'OX �1 --
Operator Certification ;Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 4 ❑ Longitude: ❑ o ❑ 1 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ❑ Layer
32c�0 fO�f ❑ Non -La et
❑
Wean to Finish
Wean to Feeder
®
Feeder to Finish
'7
❑
Farrow to Wean
El
Farrow to Feeder
❑
Farrow to Finish
El
Gilts
ElSoars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
ElTurkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current j
Cattle Capacity Population
El
Dairy Cow
❑
Dairy Calf
❑
DairyHeifer
ElD
Cow
El
Non-Dairy
❑
Beef Stocker
El
Beef Feeder
El
Beef Brood Cow
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?
❑ Yes 1XNo ❑ NA ❑ NE
[]Yes
rXNo
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0? No
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
12128104 Continued

y
Facility Number: BZ- IQ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
nor,
1 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
N No
❑ NA
❑ NE
Structure I Structure 2 f 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
[3No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo
❑ 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
[X No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA FINE
(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 altematives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
TNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
t
Crop type(s) ctpy- fj SG 1. btaA ST 61 &ituy /IS, l ilia/ e. Gray
--
13.
Soil type(s) ClodsLovnL LLB (out
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
to No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement'? ❑ Yes
EA No
❑ NA ❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[] Yes
EoNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
MNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
12 No
❑ NA ❑ NE
Reviewerllnspector Name ` K1C j [.S, , Phone:
Reviewerllnspector Signature: Date: .S-O 9-Zd`O6
12128104 Continued

4
Facility Number: Date of Inspection 5-0-D(o
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 [BNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
[9NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
CR NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[K No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N No
❑ NA
❑ NE
Outer Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12128104

r-
O
Type of Visit e Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 6 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: .?%?3165 Arrival "rime: a SD Departure Time: County: Sn �{u.�s Region: Ek"-
Farm Name: A-,, kr xec- A1:dVf10.2 F.-rn Owner Email:
Owner Name: Al.,, Aic_ Phone: 9t° �4'�- .lase
Mailing Address: � �! 4 4 /t'� � 1..'t- 12.E �' /.'.� �o u. 6L C
Physical Address: Saw. aa s a to t ,�
Cell
Facilitv Contact: Ar-Fli Kr Na y /0 h Title: Phone No: 9 9D
Onsite Representative: (4,4", r�4 f o r G. r 1;5 a r w ie,btegrator: C o a 'jc
Certified Operator: /2-7L- 2 u L- /N414Z , Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = I 0 Longitude: = ° = 1
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
a 3 ! G ❑ Non -Lay -et
® Wean to Finish
® Wean to Feeder
® Feeder to Finish
00
4 /
❑ Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
ElPuliets
ElTurkeys
[EllTurke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
El
Dairy Cow
El
Dairy Calf
❑
DairyHeifer
❑
D Cow
❑
Non -Dairy
ElBeef
Stockei
El
Beef Feeder
El
Beef Brood Cow
Number of Structures: ®'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes m No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

f
Facility Number: JI0j — le, j Date of Inspection ldlXlff
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: _AA,P- _ /:7z�y4Tk1_
Spillway?:
Designed Freeboard (in): IV
Observed Freeboard (in): d
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W 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 m No Cl 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 FXI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
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 91 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Corti, se,.t?aca,s �Cie. A
13. Soil type(s) /Vo.,e / � /�PJG� .e. �C 4AIA . rc
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',❑
Yes
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
Comments (refer to question #). `Explain any YES `answersrvwwandlo anyy reecoirnmendatlons or any other commonhs.
�a {.��
Use drawings of faclllty to.better lain sefuatia {use additional pages as necessary):
a_.
¢�t
Reviewer/Ins ector Name r Z ` "�& `�� Phone: Y /° 11=�
p Qrt ct /. x i 1 hz ._s,.
Reviewer/Inspector Signature: Date: .2 /b f
d 1 1 '12128104 Continued

A
Facility Number: Yc2 — JG / Date of Inspection a
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 $j No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[$No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[0 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
{�j No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
m No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[4 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
i tii`"" j,avy�y}T x nr Tax@+d 41 5 » #� T Fl k "Co'.
Additional CommentspAandlor�DrawEn s �`m��°; of3
e-r.-A u� r i n� rs \1 r. r :.iQ`� 0 K ptv
12128104

Facilin' \umber pate of Vkit: Time: �
/
Not O erational 0 Below Threshold
ermitted � 'e/r/tified © Conditionally Certified 0 Registered bate Last Operated or Above Threshold:
Farm Name: _"uar Lee Aay%_5rr7 County: Sadwso,q, .._.
Owner Name: Armvr Lee//l7v�vr _ �7Phone No: - (k
NlailingAddress;
Facility Contact: Title: Phone No: 1,70-- 3 5"40 -
OnsiteRepresentative: Integrator: C-0A"' "'je FGr�S
Certified Operator:. �r f��r Naylor Operator Certification Number: 985`9
Location of Farm:
Ulewine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' 0` Longitude �• C�• 0
Design Current
Swine ranapaw Pnniilatinn
Wean to Feeder
3.2CV
3000
Feeder to Finish
O
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps 0
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I I ❑ DaiI --d
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laaoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &-Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: &,s
Freeboard (inches): .217 7
05103101
J_Spray Field Area j
K�4
sy-�y
�S
❑ Yes
[lo
❑ Yes
2- 0
❑ Yes
Mno
❑ Yes
Eg o
❑ Yes
GJ Ko
❑ Yes EKO
Structure 6
Continued

Facility Number. 82 —11,./ 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes [9
❑ Yes M-No
❑ Yes ,moo.
El Yes l� lvo
❑ Yes D'Ro
Waste Application ,,--
10. Are there any buffers that need maintenance/improvement? El Yes 040
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 044
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 2-go
14. a) Does the facility lack adequate acreage for land application? ❑ Yes U-No
b) Does the facility need a wettable acre determination? Cl Yes U-No
c) This facility is pended for a wettable acre determination? ❑ Yes El -No
15. Does the receiving crop need improvement?
❑ Yes
0-tdo
16.
Is there a lack of adequate waste application equipment'?
❑ Yes
Q-No
Reauired
Records & DQcuments
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EIN-0
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[D-No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
EJ-No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
['NO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®-No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑'No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0l0
24.
Does facility require a follow-up visit by same agency?
❑ Yes
040
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Q<o
11PRo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer toque on Explain anyYS a veers and/or..anyrecammendatinns or anyEothercomm s.
llsc.drawings of facility to Bette explain situations",{use additional pages'as necessary) field Copv ❑Final Notes
r Ui .I����!Niwl!!,��e,.4...�.wr ��,u��h�
A i ee rar.n,
Pecords are well keP�
TOM �Mt y yt
Reviewer/inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or .equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name:
Mailing Add;
Cou
Owner(s) Nam
Manager (s) N
Lessee Name:
Farm Location (Be a specific as passible: road names, direcion,
m_lepOSt etC j 'a � a 1 r'f // S f �e
r7��
Latitude/Longitude if known:
Design capacity of animal waste managements stem (Number and type
cf confined animal (s)) 3,�00 0'�s ; P,'a Narseriol
Average animal population on the farm (Number and type of animal (s)
.raised) 40 P'R - -ra P
Year Production Began:. _ ASCS Tract No.
Type of Waste Management System Used: Ga en
Acres
Available for Land
Application of Waste:
Owner
(s) Signature (s) : ZVK
Z
DATE
4-
!IJ-Iq_9l
k/,pre lr,
�7 .4,3eJ
;�p
I\Q Li. f ,SjL

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep,, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name: a!2vlQr EL04xers�
Mailing Address:
Cou
Owner(s) Nam
Manager(s) N
Lessee Name:
Farm Locacion (Be as specific as poss'ble: road names, direction,
milepost etc.) • '7' r L-et
nn /33� (Rma:-A si.-4.&4i rr m:/ec ,,.d u r' are
Lat-itude/Longitude if known:
Design capacity of animal waste anagemen system (Number and type
of confined animal (s) 200�" ,(,' 6a:
,57
Average animal population on the farm (Number and type of animal (a)
.raised) :
Year Production Began:.Ly_L ASCS Tract No.:�JQQ 14
Type of Waste Management System Used: �r_ eiJ
r
Acres Available for Land Application of Waste:.
Owner (s ) Signature (s) : 1�.� -� .� ��„r, DATE.- /c -1942

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Site Requires Immediate Attention: N4
Facility No. B a - la r
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z zo , 1995
Time: �-'•35
Farm Name/Owner: N A`t ►-�� �� ua s �__ - -
Mailing Address: eZt i TS e x 03k - o C-L, ft3'-;V% u c. -Ze Z43
County: aOa'^
Integrator: Coy.a."e Phone:
On Site Representative: S%A-%= V"tt. iJ-:j t.r Phone: Se'k
Physical Address/Location: 5�_- %33 .3,.., .,,., �� ^°� N0!_
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: -.5
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h•
(approximately 1 Foot + 7 inches) (I
Was any seepage observed from the .
Is adequate land available for spray?
Crop(s) being utilized:
Does the facility meet SCS minimum
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
es r No teal Freeboard: 3 Ft. Inches
n(s)? Yes No as any erosion ed? Yes or No Is the ver crop adequate. Yes or No
C,o c e1
setback criteria? 200 Feet from Dwellin Ye or No
100 Feet from Wells) Ye o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o No
Is animal waste discharged into waterstate by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes, Please Explain.
Does the facility maintain adequate waste management recoyAj of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:_ "Z- �sGCn s
�s r
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

T
Site Requires Immediate Attention: NA
Facility No. 81 - 469
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -(2-m , 1995
Time: Z :-&A
Farm Name/Owner: a l o es _e> r o i .t
`Mailing Address: `� o S o,c 1 3, 4 - v C-A N
County:
Integrator: C,o1�.� Phone: Sg z a t s
On Site Representative: Now for Phone: S&&A - 4Cs Zlo
Physical Address/Location:_ 3 �g �R. yb't- Str�t.�� oEF '�zt 5o_
Type of Operation: Swine X Poultry Cattle
Design Capacity: Soo Number of Animals on Site: Zso
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' " Longitude: ° ' of
Does the Animal Waste
(approximately 1 Foot +
Circle Yes or No
Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
7 inches)
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: C-C>Rt4
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin Yes r No
100 Feet from Wells or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Ye or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line. Yes o S
Is animal waste discharged into water o the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oiNo If Yes, Please Explain.
Does the facility maintain adequate waste management r s (volumes of manure, land
spray irrigated on specific acreage with cover crop)? Ye or No
Additional Comments:
Inspector Name
Yes or No Actual Freeboard: 3 Ft. Inches
n(s}? Yes o No Was any erosion o rved? ® Yes or
Yes)or No Is the cover crop adequate? Ye or No
1 'f ik 1.-ft*o r%
Signature
applied,
cc: Facility Assessment Unit Use Attachments if Needed.