820179_INSPECTIONS_20171231

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NORTH CAROLINA
Department of Environmental Qual

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Ir ,,, � , ,, ,, ,, 1,lI � � 1 I � Division of Watcr,Resources
II ctltty Nutriberil I! ®- © E' 0 Division of Soil and Water conservation
I'i�' Q Ot ri' enc
r r 1 r ,�. 'L Ag
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f ype of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
teason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
IlL�lr�l �. I IIII11 IILI�L.IIII III III II LI �1111
Date of Visit: i Arrival Time: ,d J 07,F1 Departure Time: F�' County: Region�20
Farm Name: Owner Email: -
Owner Name: ff-� !"u.� ��,..--�/�� Phone:
Mailing Address:
Physical Address:
Facility Contact: �rG'� (���TI� Title: Phone:
t�
Onsite Representative: Integrator:r5�
Certified Operator: t Certification Number: 3 D
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
I.I� I ! I ,I
i :tlM I -1` h
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' ,i I IK6��{ ,I i Desi n 'Trent
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, �i.
Deli n Current`
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tI}II f J�E :�d.3 ,.77 I�d Il. , I
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u VI�etPoultr ,i,Ca aci _ Po .
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i
te, i �i i, �
I� h r :
i :�:
.Cattle '::
I
.F1
�Capacity, Po . .
;lhi#„ Layer ; ..
�" Non -La er
i IIF �i'
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�IJ
I 1 � yyJIII ' t l ip M II ry11I1, �k {tll �i I,j F 1 Des n Current
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��-......
�,�141.o.,D" ,iPoult Iilla;,Ga aci IPo �>,1,l ;
La
. 3
l ers , li'
1
i
Non -Lavers'
Pullets
Turkeys
.all `I
rl, � �.� TurkeyPoints i I
, I
1F Other r" Other , f
i I:
i !' t
,I
(� ir�llll lit Il I E 1 2118111
Discharges
CurrentpaClty
Wean to Finish
�, ,
Wean to Feeder
a�/�
S5 L
Feeder to Finish
Farrow to Wean
Farrow to Feeder
IIIII
Farrow to Finish
Gilts
Boars
and Stream Impacts
1.
Continued
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
Is any discharge observed from any part of the operation?
❑Yes
[-j'1 0�❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other:
a. Was the conveyance man-made?
❑Yes
❑ No
C3-iQA'
❑ NE
b. Did the discharge reach waters of the State? (]f yes, notify DWR)
❑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 DWR)
❑Yes
[] No
L.__I ""
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
❑�O
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts'to the waters
❑Yes
[-] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015

. Facility Dumber: 7..- Date of inspection: SyQ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E>o—❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑CIA ❑ NE
Structure I 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 [`Flo ❑ 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
3,N'
❑ 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
[g-N`o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3--No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E;kNe
❑ 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 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 Drift ❑ Application Outside of Approved Area
12. Crop Type(s): +-� e". 1 S (0 ')
13. Soil Type(s):('6;4cwt _ ! `10
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes [] 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 �No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [J oo ❑ 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 [P�o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fa�il� Number: - ` Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3''N-o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ED IN_o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [a-Nfl ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.t*�- 7—(7 - c? ­3 t. I
❑ Yes [E �o ❑ NA ❑ NE
❑Yes [] o ❑NA ❑NE
❑ Yes ['I5 ❑ NA ❑ NE
❑ Yes E2 5o ❑ NA ❑ NE
❑ Yes ©'i�o
❑ Yes [n No
❑ Yes D'N-0
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
c,t( I
1 �1 V4 Phone- 0-
t
Date:
21412015

vision of Water Resources
eiacility Number FW7� - 0 Division of Soil and Water Conservation
0 Other Agency
Type of,Visit: omplianee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (EKRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L(! Departure Time: County: S, Region:
Farm Name: NkT Owner Email:
Owner Name: t { Phone:
Mailing Address:
Physical Address:
Facility Contact: �t' S'ti �ti�" Title: Phone:
Onsite Representative: Integrator:
Certified Operator: �( Certification Number: r 3b Q
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
oars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
4NNLon-Layer
a er30go . I I El
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dischames 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [a'1Go ❑ NA FINE
❑ Yes ❑ No [VIVA ❑ NE
❑ Yes ❑ No [2-IGA ❑ NE
❑ Yes ❑ No
❑ Yes [lNo
❑ Yes [TNo
[�'<A
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412015 Continued

[Facilky Number: Date of Inspection: j sr—gf
Taste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �� ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats totheintegrity of any of the structures observed?
❑ Yes
Fe�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[20No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate puhiic health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[J%
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(2 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
❑ef4o
❑ 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 Q o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[]Yes
['�io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ -N—o
❑ 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
[2'gio
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[No
❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑ 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 V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[yNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facill Number: Date of Inspection: csc
�4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]-Iqo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes e'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes to
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes E lvo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Other Issues
28. 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E N
❑ 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
�o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E]"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
C No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[5"No
❑ NA
❑ NE
Commcntsi refer:fo;. uestion ##: Ez"laln an YES answers andlar`an gad'dlteonal5'reconimendations'oianyotFier
comments
`; �r ;,;
us, c drawings offacillty_ to,better>explain`situ'ations, (use; dttitionahpages<as
ej 0.3.
lwReviewerfInspector Name: 0 Lt Phone:w
Reviewer/Inspector Signature: Date:'
Page 3 of 3 214,42015

BIAS oll T-t-t I6 ID
Grgivislon of Water Resources
Number ®- O Division of Soil and Water Conservation
Facility
Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 919outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: D Departure Time: County:
Farm Name: G'"'' Owner Email:
Owner Name: N 1�'1, r'� Phone:
Mailing Address:
Physical Address:
Facility Contact: r, lCJ'%— !Sol, 4'e--7 Title:
Onsite Representative: [
Certified Operator: 'i I
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
`2.
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
Latitude:
Region: 71E?
Integrator:
Certification Number: R'3
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys _
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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
Dl:QA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑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 DWR)
❑ Yes
❑ No
<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z�go
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters (Dyes [ Rio ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

FacilityNumber: Date of Ins ection: a�Cjkj
-
�Vaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ffT5o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes &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
I_J o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify 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
��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
L2No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [fNo ❑ 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 Win ow ❑ Evidence of Wind Drift Application Outside of Approved Area
P TYP(): LJ (O1 12. Crop e s C.ctjC., (� P��
�Ci
13. Soil Type(s): Al rlo"_ - A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[B No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3INo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[v]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box,
❑ WUP ❑Checklists ❑ Design ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 52<0 ❑ NA ❑ NE
❑ Waste Appliocation ❑ 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 KNo
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility•Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FB'lqo' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 810 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [R o ❑ NA ❑ NE
Other Issues
28. 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 ENo
❑ 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 0 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Ef'V 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 �o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Ellp"o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary),
ReviewerlInspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
V
3,s
Phone: I 7L]) I
Date: ( Iau I
21412014

IMs Ia��dis_ ��
G"lvislon of Water Resources
Facility Number ®- 0 Division of Sol] and Water Conservation
0 Other Agency
Type of Visit om�Hance Inspection Operation Review - 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: G70utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I Iii ounty; �T Region: ��
Farm Name: / 13 w`�✓_ Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: r c
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
Boars
Other
Other
Z*%141 -` Title:
Latitude:
Phone:
Integrator: I
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La &
Pgolzdon-Layer
Non-L
Pullets
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
N
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑i .I<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ 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 DWR)
[] Yes
❑ No
Q4A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[:?No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
,j No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: Date of Inspection: 7F:Z IS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ®NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?;
Designed Freeboard (in):
Observed Freeboard (in); S� n
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ 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<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑'W
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes l� 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 ❑-N�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [37�°
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CKO
❑ 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?
0 Yes
(gVo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[1d6
❑ 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
hCeKo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0'1';�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes []'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2 014 Continued

Fatili Number: 6- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q�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 E lGo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑< ❑ NA ❑ NE
[:]Yes 0-9-o ❑ NA [] NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes ©-< ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
hio
[DNA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[21"No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
r1lg+i 9-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3
Date: — La !• <
21412014

3 -17-- r
Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Reason for Visit: Wutinq. 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access � �]
Date of Visit: Arrival Time: Departure Time: County y Region�W
Farm Name:1 �,, Tf �- I t T Owner Email;
Owner Name:N666� )&d!{v. Phone:
Mailing Address:
Physical Address:
Facility Contact: N��_RTitle: n%2/P, �r/ t Phone:
Onsite Representative: 1 1
Certified Operator:
Back-up Operator: t e�
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
7
Integrator: tri4­e�
Q f
Certification Number: l6 " ��t/
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Nan -La er
pry rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
0 No
[3 NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
PA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
.11
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
ONo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []kWe— ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [3..�e ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ra o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�'1Vo ❑ 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 .43-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0'�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
E<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J�JNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[;J1 "'
❑ 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?
❑ Yes
(ZLNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R'Io­
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[911 oo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
®-IToT
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ca>e
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
��
LLd'1VO
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
'f'�`
❑ NA
❑ NE
the appropriate box.
[] WUP ❑ Checklists [3 Design [] Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑'<
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EWEINA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of inspection: 4K2tp'
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2Ior
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Iq 1Vo
❑ 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
J2-fo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[D>o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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?
Reviewer/Inspector Name:
❑ Yes FA o ❑ NA ❑ NE
[]Yes UiNr ❑ NA ❑ NE
❑ Yes GD NKo ❑ NA ❑ NE
❑ Yes [ <o ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
YesNo ❑ NA ❑ NE
❑ Yes FNo ❑ NA ❑ NE
Reviewerllnspector Signature:
Page 3 of 3
21412011

�i
&'Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation l
0 Other Agency �o N
Type of Visit; QD Cam Hance 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: Arrival Time:I 22R@� Departure Time: County: Region:
Farm Name: 3- , ILj-K Owner Email:
Owner Name: �✓` Phone:
Mailing Address:
Physical Address:
Facility Contact: my -elite gw`
�(�✓'
Title: (1jWAJU Phone:
Onsite Representative;
L
integrator: 0
Certified Operator: Nkro'1
�j 1�G✓�
Certification Number:
V.
9 _4 0
Back-up Operator; T,,
9
Certification Number:
! i L3 ` 19
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 3'0 0
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream Imnacts
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
eNo
❑ 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
[jT"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5No
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Q No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): g
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
Pio
❑ 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
ErNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RrNo
❑ 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
53"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
FP*I�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [0"'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 rift ❑ Application Outside of Approved Area
12. Crop T & es: -tt e SeI
13. Soil Type(s): �19✓1 �% ��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �To ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [j�Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ga"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CU4o
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
62
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5No
❑ 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 rNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r Facili Number: g2,7727 7 Date of Inspection: 2O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fNo
1
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure -a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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?
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes
250'N'o
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
MrNo
❑ NA
❑ NE
[]Yes [✓ lNo ❑. NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
[:]Yes Vo ❑ NA ❑ NE
[:]Yes ZNo
[:]Yes ZNo
❑ Yes ff No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any.other comments.
Use 'drawin s. of facility to better explain situations use. additional pages: asnecessary),
Av'-�
S "fin 1" a 49A
E40'�Etk 6
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
Phone: (b- 33`3
-,aq
Date: A (�
21412011

ivision of Water Quality
Facility Number ®- 'j q 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: QCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Q 'a- Arrival Time: Departure Time: County
Farm Name: N '� s�1 P.2 Q�rA{�sn Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: iA l: _� S(ari —a,-At e R Title: (5W "L iL Phone:
Region: rRZ
Onsite Representative: 21aML Integrator: ?RL5; t 1<
Certified Operator: �grnf Certification Number: 1%'S Lev -
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
ct
Discharees and Stream Impacts
ro
Non-L
Pullets
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes a) 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)
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
[] Yes No
❑ Yes No
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: !
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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
No
❑ NA
FINE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[K] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a F.Ck M r j'0f-\
13. Soil Type(s): ]�)IA tuTyN IVoD Koii<
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
C& No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
R] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(4 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [] Design [] Maps [] Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Qq No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CE No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -9 jDate of Inspection: L41 IZ.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[]Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA [a NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
M 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
[K No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Co No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES.answers and/or any additional recommendations or any,other comments'-
Use drawings of facility to better explain situations (use additional pages as.necessarv). .
Qzo 0 V R v-\ - W e_11 \4 k
Crodo RF.e-o -3�5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ta f
21412011
I

i
UrDivislon of Water Quality
Facility Number ®- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: G<=pliance 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 0 Denied Access
Date of Visit: -3t Arrival Time: �,3 Departure Time: D County:,�.�yf,� �---
Farm Name: Owner Email:
Owner Name. T tt I !fit` Phone:
Mailing Address:
Region:
Physical Address: Facility Contact: O e, 16IY - Buhr Title: �I n � Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: /19rV3 11 0
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Non-
Pulle
Other
Poults
Design Current
Discharyes 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 ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: -Za Date of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q 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
R 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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste A[ mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 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): I 0_e1_S _Z
13. Soil Type(s): xl cJp �k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EINo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
RemWired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rVi No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists [3 Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ED No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: r'o 3 D!
y 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®.No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [c No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes � No [3 NA ❑ NE
❑ Yes [S No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any VES answers and/or. any additional recommendations or'any other°comments::
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:/,
21412011

r,
r
0-ivision of water Quality ."D'
Facility Number O Division of Soil and Water Conservation
C) Other Agency
Type of Visit ,,ommppliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Ly Reason for Visit 'Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i Departure Time: County: Region:
Farm Name: V- T- 2- r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: hl�P ` 1314-fl►r Title: cnf&& vr-✓ Phone No:
Onsite Representative: .S Integrator:
Certified Operator: `j '"� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Boars
Other
❑ Other
Latitude: n 0
Back-up Certification Number:
=" Longitude: = ° = I = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
O ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Daity
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
ONE
El Yes
'No
El Yes
91No
El NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

`Y
Facility Number: 8'� 1 7C Date of Inspection 1 /,;2 o'0'�G�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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
Q§. o
❑ 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
ENo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WYo
❑ 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
KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
& No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) !��oryu.-molar /t9tt�✓✓++�i.(
_ ..._
13. Soil type(s) � x:�b•-�� I +Npr'`�1Artm
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Lou No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
09No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O,No
❑ NA ❑ NE
oaf -'#.g .. •. r :,: r" Px y e.<fi3 v. x4k.4'il-111-`14 Y. d:}"
Comments {refer to questinri #I) Explain anyrYES;answers and/Q'r any recommendations or any, other Tom enfs.
l r x i. i ,: , ' � .: � -
us arawi gs��f facility to b iter, explain situation (uscAadditiio.nal�pfiages u nec sary). ,v
AL
Reviewer/Inspector Name , d f Phone: /p-y,33-'33D
Reviewer/inspector Signature: Date: 1'7L 'A0 =2PLO
Page 2 of 3 12128104 Continued

a
Cy Facility Number; - 7 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 El Maps El Other
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes 59 No ❑ NA ❑ NE
12128104

Type of Visit
C,-0m-�piiance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
l,! • outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 122ZTET Arrival Time: 0 Departure Time: ' D Q County:
Farm Name: Pr �a try Owner Email:
Owner Name: __Qe_ 1fO - lZ t _+j,f r Phone:
Mailing Address:
Physical Address: tt� r
Facility Contact: f�-�� r so''`' eot Title:
Onsite Representative:
Certified Operator:
Region:
Phone No:
Integrator: Jr- ?76 ���„
Ar
Operator Certification Number: joc� (" 0
Back-up Operator: Back-up Certification Number:
Location of Farm:
Design Current
Swine Capacity P U aIIor,
_❑ Wean to Finish
Wean to Feeder bii O 3 6 0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Latitude: ❑ o ❑ 4 ❑ Longitude: = ° ❑ ' ❑
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
C•attte iff aeity Populatlon
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
[jNo
❑ 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)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®.No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®.No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatnt:ent
-
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure ? Structure 4
Structure
Structure 6
Identifier:
Spillway?:
Designed freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
( No ❑ NA ❑ NE
(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
[R No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
A No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
-II,,
VISNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or to 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) pQ_V_
13. Soil type(s) n�-.`f�---- �oi�F6 fl—,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNo ❑ 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 acre determination , [] Yes RNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 5No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
tommetits (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):
AL
Reviewer/Inspector Name Phone: ` 10- 4el3 r3301
Reviewer/Inspector Signature: Date:
12(28IU4 Continued

Facility Number: — 12 Date of Inspection D
Rerluired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g ❑ Maps ❑ 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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? [:]Yes UNo ❑ NA- ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [9No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C&No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ NA
❑ NE
Other IStines
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[YNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fR 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
9 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
(5�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[�INo
❑ NA
❑ NE
al Comments and/or Dra
12128104

.I
K4
vision of Water Quality '5'P_
Faeility Number ? O Division of Soil and Water Conservation
O Other Agency
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 01foolutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: y !� Arrival Time: .'D i) GDeparture Time: County: Region:0
Farm Name: N �� Latec � I ar'Owner Email:
Owner Name: >���fa��- tf� ���/'Phone:
Mailing Address:
Physical Address: ,�I
Facility Contact: A/ r_ /rb L13 is l` r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: /rs�a�-lv:
Operator Certification Number:
Back-up Certification Number:
Latitude: =1 o =1 = Longitude: 0 0 =1 =
16
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
O C� ❑ Non -Layer
❑
Wean to Finish
®
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: IL
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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes ZINo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
ELNo
❑ NA
❑ NE
12128104 Continued

i
Facility Number: — Date of Inspection `v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): .12
Observed Freeboard (in): 3.�r
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 EgNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 5 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 21 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 ER No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ER 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) ZDI"�/,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LrAMJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
® No ❑ NA ❑ NE
® No ❑ NA ❑ NE
8No ❑NA ❑NE
[&No ❑ NA ❑ NE
:: _Y i'.ro�, .s b.df :a�.:>ws�44xz-^5..5-r.
Comments (reter,to questtonj#) Explain flnyYFS answe"rs and/or anyrec omrncndations oranyfothercomments''
'Use drawings'of facility to bctteraexplatn situat��ns(use�add�t�onalpages;as�tnecessary=}:
f,
_ �r on
Reviewerllnspector Name �� Phe• 91LOA 5�00
p�---
Reviewer/inspector Signature: Date: 6e—
Page 2 of 3 1 / 12128104 Continued

Facility Number: Date of Inspection ?�
1 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP [] Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z,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
3No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Z 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
J@ 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
JW No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Comments and/or Drawin
12128104

Facility No. &a— 12 2 ,_^ Time In Time Outer Date
1 j e I e r Integrator
Owne iv d �i-' f i ��" Site Rep
Operator No. >
Back-up Y No.
COC Circle: eneral or NPDES
Design
Current
Design
Current
Wean -- Feed
Farrow — Feed
Wean -- Finish
Farrow — Finish
Feed — Finish
Gilts I Boars
Farrow — Wean
Others
FREEBOARD: Design
Observed 33
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard ✓ Daily Rainfall
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
.,..._..
4,► 3. C)
Sludge Survey
Calibration/GPM-
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
Pull/Field Soil Crop Pan Winslow
41P

ivision of Water Quality
Fae�lity Number O Division of Soil and Water Conservation G . /�-�% ,•r
0 Other Agency
Type of Visit 9tompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CN'Routine O Complaint O Follow up O Referral O Emergency O Dther ❑ Denied Access
Date of Visit: I ti�1j Arrival Time: Departure Time: 0 County: V''..—
Farm Name: 3 fAw�+!Tr` ��- l ltyL Owner Email:
Owner Name: 9e_4. z2rL Phone:
�T
Mailing Address:
Region: _i 0
Physical.Address: 'y
Facility Contact: � `r� � Title: Phone No:, �O,--6
Onsite Representative: ��geat_ Integrator: ill r
Certified Operator: �_��Z^� Operator Certification Number: 1 4-3Ly
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = 0 0 I = Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
113(V 70 I 10 Non -La cr
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
o Q { = ll
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Fleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
❑No
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
12128104 Continued

Facility Number: —1,79 Date of Inspection 1 (0 - /P-P%
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes C� No
❑ Yes ❑ No
Structure 5
❑NA [I NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 1•
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes `V 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 ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5&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 19 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [4 No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9No ❑ 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) 11 Ly rs V-e. „,---
13.
Soil type(s) &w 21 rLL
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
12 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RA No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
LX No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
X No
❑ NA
❑ NE
Comments (refer to question #):
Use drawings of facility to bettfa'
Explain any YES answers and/or any recommendations or any other comments.
explain situations. (use additional pages as necessary):
AL
Reviewerfinspector Name
, yn— , ,;. " ti; �" ^_ Phone• _T
• 9Z2 33�
Reviewer/inspector Signature:
Date: %
12128104 Continued

{
Facility Number:ng= — Date of Inspection �f 7
,j Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M 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 KNo ❑ 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 [9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [KNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�R No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E] Yes
jNo
❑ 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
[Z 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
X 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
U1No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[.No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit CYifo'moance 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: Departure Time: ; .3 Q County:—s a-" Region:
Farm Name: i11T d- i h u7fL r. r- �'j2 Ea en— Owner Email:
Owner Name: l"y- L S a r- o�- tTej!�tsZ y Z r-r' Phone:
Mailing Address:
Physical Address:
Facility Contact: I( _ one __ 4* 1 e r - Title: Phone No:
Onsite Representative: Integrator: �Z'Ir'STa- p e—
Certified Operator: S�� Operator Certification Number: /s-3s�
Back-up Operator: ' a''`r U* r- r_ Back-up Certification Number: LL-3 In a
Location of Farm: Latitude: = ° Longitude: °
Design
Swine Capacity
Current Design Current
Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
JEI Layer
❑ Dairy Cow
' Wean to Feeder 3 as/ a16,141
1 ILI Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Feeder
❑ Boars
ElBeef Brood Cow
El
❑ Turke s
urkey Poults
❑ Other
Othe
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
%LNo
❑ 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
4 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[A No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[O No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: —
Date of Inspection 1 CIP
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
Identifier:
Spillway?:
Designed Freeboard (in): ! !
Observed Freeboard (in): 3 D
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [SNo ❑ NA. ❑ NE
[:]Yes faNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes � No El NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L9 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) _ �/' n� u eri a �-7 1 W r,�#rP Y� d s*r S�prJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZjNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes ®No ❑ NA FINE
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 M No ❑ NA ❑ NE
C-7-00d orym - d-(-eaofz.
Phone:
Reviewer/Inspector Name '"' }' "
7' lJ ''=s. w :
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection 3� 4p
'�. Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M 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 99No ❑ 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 [A No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [9 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
K No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[& No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
i 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
X 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
RNo
❑ NA
❑ NE
A'ddltional Cominen'ts and/or Drawings
12128104

Type of Visit 6 Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
pate of visit: Arrival Time: Departure Time: County: S Or"A=N Region:��
Farm Name: N �ufi�e� P' Ira Im Owner Email:
Owner Name: — _A o,v __" _ c.r YPhone: - Mailing Address: 4 F,3 010 R k. C 1A +0 C. a�3 a8
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: P
Certified Operator: ��-•{"�-��Ct Operator Certification Number: _ 1,8340
Back-up Operator: �ryT Qv1Y5�tiZ _ Back-up Certification Number:
Location of Farm: latitude: ❑ e a 1 ❑ f1 Longitude: ❑ ° = ` = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
p 0 ❑ Non-Layet
❑ Wean to Finish
® Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
ElLa ers
ElNon-Layers
El Pullets
❑ Turkeys
El Turkey Poults
El Other
Discharacs & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made`?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
❑ DairyHeifei
El Dry Cow
ElNon-Dairy
ElBeel'Stocker
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?
L®
❑ Yes [Z] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

1
.Facility
Number: y.2 — Date of Inspection a /ar•
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in): T1ekc ;,, %I *�ue.kb —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
59 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
N 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
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
IN No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload El 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) err►-�ct d rn Q.II �0 S
13. Soil type(s) nrs.{.p i�( o r �0 1
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 N No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination': ❑ Yes [59 No
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [J@ No
❑ Yes P No
❑NA El NE
❑NA El NE
❑ NA ❑ NE
El NA El NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12/2&04 Continued

Facility Number: 8 ;2 —) i Date of Inspection EYTO ITT
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Wcre any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
IN NE
❑ Yes
[N No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes ® No ❑ NA FINE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes [19 No ❑ NA ❑ NE
❑ Yes (9 No ❑ NA ❑ NE
❑ Yes
[j No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
; k x t k''
Ne-W C,MWt"�P �S "9W ��..
�ide-c
-ta rc41eC.+ 1%-,cIF_ ,
Lo.I ouPj otC.�tIr` � b V%0-C r; v1
-Ir��
tOr�yG�-'CeCOv�b.
{ y@aaQ_
Seck�e. a Cope o-9 +k%e-
1Q�bo,.
oQca�sr. t-or �o�v
r4.c�o�-�s,
Ca t�b"'4-tow% a^cQ- 61%A-09-S'e- Swruei
cAk 6-1 0 c+.
12128104

r
COilserVa,t�l�OII 3� fib;`
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 4 Date of 1•isit: a7 Time:
10 Not O erational Q Below Threshold
Permitted 0 Certified 13Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
n FR a
Farm Name: _ � J Qufl*er Yin iear.,., County: .Sar•►
Owner Name: IUe-Iso u t G rrT_ Phone No: _ 10 .se-Y — y O83'
Mailing Address: ��3 t7Orars� /�nQ. � .i8s;i8
Facility Contact: Title: Phone No:
Onsite Representative: ALIr integrator: PrC c_461 r. F't &--.A
Certified Operator: — Ne, tlt� IQ..+r>t->tr�. Operator Certification Number: M3 Gd
Location of Farm:
Pwine []Poultry []Cattle ❑Horse Latitude �• �' �" Longitude �• ���
Design Current
Swine ranacity Ponulation
Wean to Feeder
OHD
3 DSO
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ce acity Population Cattle capacity Po uladon
❑ Laver ❑ Dairy
❑ Non -Layer ❑ Non-Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons " ° ]E] Subsurface Drains Present [] Lagoon Area U Spray Field Area
,.Holding Ponds / Solid Traps
❑ No Liquid Waste Management Svstta'in i` K
Qischarges 8 Stream Impacts
I . Is any discharge observed from any pan of the operation? ❑ Yes 00 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min? N110
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M•No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
& Treatmen
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpiIlway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: 1
Freeboard (inches): rf
05103101 Continued

Facility Number: S..2 — 17
Date of Inspection 1 11121? 1011
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?
Waste Annlicatlon
❑ Yes W No
❑ Yes 5[] No
W Yes ❑ No
❑ Yes X No
❑ Yes a] No
10. Are there any buffers that need maintenance/improvement? ❑ Yes [19 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [A No
12. Crop type 46ttrrobd'a go�z / S!'ha 11 i�ra: OS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes (I No
b) Does the facility need a wettable acre determination? ❑ Yes P No
c) This facility is pended for a wettable acre determination? ❑ Yes 156 No
15. Does the receiving crop need improvement? ❑ Yes ® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Q0 No
Regljired
Records &-Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[ No
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
m No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q9 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
X No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[M No
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[N No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,l 1 Co� Q7 € , {IIIII-, .. 6 j, i,.: : yk: ..�;' ,..:' i{ �I i" E .��i '�`'
to question}!i) Explain any Y)y 5;answrers and/or�atty recommepdatiotis orVaaye�tlter--cn�inmentsr�
Emment�i(refer � � �^ r. _ . f�.`
UseJdrawings of fi�cilityto better explain situations'46se additional pages as necessary) " �.
{ `� FO : Field Copy El Final Notes
+C t.sd•1c. on 64rp6}s ooAj
Rcw►oVt r`iG iM'ownn� cma.afa1 .��6� c.� ,s'dOh Q.S. P0S.Cair�t +Q
y F} P -,h �t� E' i ni 9..� E �.al��{�F t»..-' r...•... { .....� , _y. -..
Reviewer/InspectorName
Reviewer/Inspector Signature: Date: 1T ID
05103101 -1 Continued

Information'contained in this database is from non agency sources and is considered unconfirmed.
Animal Operation Telephone Log
DWO Facility Number $2 — 179
Farm Name INU Butler Pig Farm
Caller's Name Jerry Butler
© Reporting O Complaint
Caller's Phone #
Access to Farm
Farm Accessible
from main road 10 Yes O No
Animal Population
Confined 0 Yes 0 No
Depop 10 Yes O No
Feed Available 10 Yes O No
Mortality 10 Yes O No
Spray Availability
Pumping
Equipment 10 Yes O No
Available
Fields 10 Yes O NO
John
Date
3-21-2003
Time
Control Number
12073
Region
IFRO
Lagoon Oucstions
Breached
10 Yes O No
Inundated
10 Yes 0 No
Overtopped
10 Yes O No
Water on
O Yes O No
Outside Wall
Dike Conditions
10 Yes O No
Freeboard Level
Freeboard
Plan Due Date Date Plan Date Freeboard
Inches
(?equals blank) Received Level OK
Lagoonl 18
3I2312003
Lagoonl
Lagoon3
L._J
Lagoon4
Lagoons
Lagoon6
Comments2

Site Requires Immediate Attention:
Facility No. 7 _
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address: (vim_ U
County:-1M,05��
integrator: --
On Site Representative:
Physical Address/Location:a
r=f,e-sf L. v Al
DATE: 7 —l1' , 1995
Time: -
rJolo
-1--la �k
Phone:
Phone:
�I .,_.,%A./
Type of Operation: Swine i/ Poultry Cattle
Design Capacity: Number of Animals on Site: 4
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:° 30" Longitude: 78r °"
Circle Yes or No
Does the Animal Waste Lagoon ha sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Ac Freeboard: Ft. D Inches
Was any seepage observed from the n(s)? Yes or "as any erosion observed? Yes Oro
Is adequate land available for spray? a or No Is the cover crop adequ te? es of No
Crop(s) being utilized: 5
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinge CY�J or No
100 Feet from Wells? &W or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o>R
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue me: Yes or
Is animal waste discharged into water of state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate wastE management reco (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) (!,ej or No
Additional Comments:
V�•r. JOn4.s 6vj
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

NORTH ChROLIM DEPARTNIM OF ENVIRONMENT, BHALTH' 3 NATML L RNSOQRCES
DIVISION OF ENVIRONI(N'IAL MANRCMIMT
Fayetteville Regional Office
Animal Operation Compliance Inspection Force
".1«s/�:1:A I�r :,Mil Y�:<.Nl+tir a:P7 ^y'1•
�. i, 1. . , ��� �. }. Aro ' .Y�`.u'Ry!M•V'FNN'it5 •iy
-' " -: �
�:a'.� r:Yn i vy✓S%^'MM:S.+i!:•l:.:L�:
� � ,�• d � F
i�Pr�r'iIM+A y'
4�%.•e .... t �N
4M.r ••1.�. �.:..�• •..,,� '
L `. ',- .
- �i.l.,..
r. . i ll1�J-6/. H $.�'.''.''"y,S'?k';"•w:,";%• ,a
:Z1LTEi,
iFAR : •}
u elson Derr 801ke
- ....f.,. n•,.y.. r.. Y �'.4n+' F .N..I�!, ...... M 1
JIJ. �. -
�y�*� rr��} ••����77�,++ �w}�ppp� y�.�.ti:bfi
•�4v.e:<S4wiiLiW
.:....�..^.. a.�.v YM
.+• yp .iS 'i o-✓ ..'��',i>� :4'4��W: ry.. �s M.•!f'.`rylaJ:.' �.:,.'Nir+ wf !,
f :.wr• • M
.CSC ]°P^ �y y�* � p� �,1 a •. w' w
�I�% t <..... •.. r
83Wum 2d. Climmm ZF).3ab
T (0/)6) 5[0 -4 31
All questions answered negatively will be discussed in sufficient detail in
the,Comments Section to enable the deemed Permittee to perform the appropriate
corrections;
imal 01paration Tvl>a: Nurser
Horses, cattle, 0—WiDne,
poultry, or sheep
1SLi`CsTION it
Y I N I COMMENTS
1. Does the number and type of animal meet or exceed
the '(.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000),.and
poultry(30,000 birds with liquid waste
mystanj
2. Does this facility meet criteria for
Animal operation 1RE
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a g0TITIED AriZlsAL
EA5TXAN1',G2MEN'P PIW
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
6. Does this facility tweet the SCa minimum
setback criteria for neighboring houses,
wells, etc?

� SSCT2CIN ICI
Fjeld .git�e I�lariagesn�nt
1. is animal waste stockpiled or lagoon
construction within 100 It. of a USES
May Blue Line Stream?
2. Is animal waste land applied or spray
Irrigated within 25 ft. of a USOS Map
Blue Line Stream?
3. Does this facility have adequate acreage
an which to apply the waste?
4. Does the land application'site have a
cover crop in accordsnce'with the
t:SRPICATION PLAN?
5. Is animal waste discharged into waters of
the state by maze -made ditch, flushing system,
or other similar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
MP) of the approved TIF CATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _)
S. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
§99T19NiY
C s

� „ • iP
J t;`jA r
U
04
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.XIZMML WAJT3 PLAN CSRT27LCATIQN FOR sw OR .1. 2jurz.= FZZ: LOTS
Plaaae rat=== ta* oOMPIetad far= Ca WS WViaioa of 3=XKXM .=aa.tal x=rasamaat at
the adtraaa an t.,he rava.rse side of tea !a=.
Mme
01 ease .print;,. �r
Addr es S
—• C 1_'"^�""' �'� Sty` Phone Np.: -ly -"M77 <
County: •.:d
Farm=ocatior.: iac'_tude and Longitude :a" -L 5a" /?8° �'r So (r eK,:irsd) . Also,
please attach a copy of a county road map with lccacion idertiiied.
flee of operation (swine, layer, dairy, etc. ) : _S j f, W-
casign capacity (nu=her of animals).30440- - W-E,ors-Egggeg
Average size of operation {12 acne ;population avg.) _04.0 WEAn
Average acreage needed far '_and application of waste (acres) 7.5
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Tac rical Specialist ca,: _ification
As a technical Specialist designated by the North Carolina Soil and '+pacer
Wnser7atior. Commission pursuant to WA NCAC 6r .0005, 1 cer_i r that the new or
ex7anded ani::al waste management system as installed for the !a= named a ove
has an ani=al waste management plan that =eets the design, ccnst_.:ction,
aeration and maintenance standards and specisic.atiors of tie Division of
3Av0or=erzal Management and the USDA -Soil Consec:at_cn Service and/or the N0170_
Carolina Soil and Water Conservation Commission pursuaZI.t to _SA :rCAC 21i.0217 and
15A NZ C Sr .0001-.0005. The following elements and their =orrespcndVq mini=um
c,itaria- have-heen yer_:_ed by me or other designated technical specialists and
ara included 0 the plag, as applicassle: minimum separations (buffers) ; liners or
eq:i.- al art to, lagoons or waste storage ponds; waste sr,orage capacity; adequate
gga:.ti :y and ameurt of land for waste utilization for use of third party ; access
or vvmershi; of ;raper waste application e0ziprment; schedule _or timing of
a;;Acations s application races; loading rates; and the: control of the discharge
ofpollucanna -rom ztor--wacer =unoff events less severe Can the 25-year, 24- :our
Stara.
Nara of Tecb=ical specialiat (Please Print)
Affiliation: +�F?ESTAGE F. aMS ,Sne-.
Address (rlgenc�} : .O• 4 rn b /JG 283x ?bons Nc.
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Cwaer/'XA=Agar Arraemaut
(;.re) ur_derscard the operation and :maintenance procedures established in the
approved animal waste management plan for the farm named &cove and will i:apleme_nt
these procedures. I (we) know that any additional ex;ansion to the existing
design capacity of the ;paste treatment and storage system ar conswaction of new
facilities will require a new certification to be submitted to the Division of
Z.virommenzal MAcagemenc before the new animals are stoc.Ked. 1 (we) also
understand that there must be no discharge of animal waste fwn this system to
swAace waters of the state either through a rsar.-made conveyance or through
nCf! from a 5LOr r event less severe thazi the .25-yea=, 24-hcu'= storm. The
a.prcved ;lan will he filed at the fa_-m and ac the office of the local Sail and
Water Zznsezvazion Mist=ict.
:t=a c' wa=d Cw--e= (Please Print) :
Signazwe —
-1) ��-�.. Dace • 3 // 5
:loos& of Y1aragar, if different fr oiss: owner ( Please print)
Signature: Date:
gM : A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
O nviror_^ertal uanageme_nc within 50 days or a title transfer.
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