820186_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

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` FaYctl��� Nuimber Ip' �% F t, Q- D[vision of Soil afid ,Water, onscrvutioni
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Type of Visit: 4bCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: p/r ^Departure Time: 'Qfl County p�''v Region:
Farm Name: �Pir Owner Email: �--
Owner Name: � Rome l Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: "ty �D� 11', 50e, -_-
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream ImD8ct3
Latitude:
Phone:
Integrator:
Certification Number: 9 r
Certification Number:
Longitude:
i a r % t Ff i1t r y r -, i i - h 11 l r iL �. w _ �r r r'y , �„� , .l y pr
il�,1a y 11 „1 "" �Y�i%1g:, n`� Current Design Current
Wet �Pouftyry "', ,', rapacity ,�i i�i P°p, E �i7 h= v.1,r Cattle �t . ��� ` Capacity :.,,,';Pop.
1 �
r , �., r Y
I.!ha�i[ill,rrti,:, 9 '# ii r Rt�,'Irq Y i ,l ,j,}.i,i € # ,ar�fi, i i y rsz6y1i r Y �7
II l�Y y I i• Design Current i
� r
Dr v. Poultry_ }izi �Cappcltvh'}<.,P..,op a
`'. Alt
_
Layer
Non -La er
I
EEJ
Non-L
Pullets
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
S Turke s I 1 1.V�,�;�
ITurkey Poults
'yy
Other
I. Is any discharge observed from any part of the operation? ❑ Yes E3kNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [] Yes ❑ No r NA ❑ 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)
2, is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ❑No �NA ❑NE
❑ Yes NO No ❑ NA ❑ NE
FU
❑ Yes y No ❑ NA ❑ NE
Page I of 3 21412015 Continued

f
Fa ility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No JBNA
❑ 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
0
❑ 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 10 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [—]Yes 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 No ❑ NA ❑ NE
maintenance or improvement? 17�
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 P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window N _ _❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (ICL��►' `�'�[9c V��ss Ll'7Q-,., JWI �Vt ocxp
13. Soil Type(s): sae
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 M No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes gpNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Y1_1No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transers
❑ 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 [21 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1� No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Ni[mber: 92- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ 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 F"o ❑ NA ❑ NE
T
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes P 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
❑ Yes No
❑ Yes No
❑ Yes I YII No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
�0 No
❑ NA
❑ NE
❑ Yes
r] No
7[D
❑ NA
(] NE
❑ Yes
No
❑ NA
❑ NE
Phone: qt0-3
�r33to
Date:
21412015

® Division of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: it Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rival Time: D� 00Z70 Departure Time: IT County ✓ Region:ef
Farm Name:Arrival G✓ �"�`� Owner Email:
Owner Name: (' WS.S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: y
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator; fer
Certification Number: le 7 L1k
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er I ]E��]
I El I Non -La er
Design Current
Dry Poultry Canacity Pnn.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
DaiEy Heifer
Da Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
ONA ❑ NE
� NA ❑ NE
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 IoNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes C] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Flacility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4
T
Observed Freeboard (in): 3L f
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
No ❑ NA ❑ NE
No 0 NA ❑ NE
Structure 6
❑ NA
❑ NE
❑ Yes
No
❑ Yes
P�bNo
❑ 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 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes toNo ❑ 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 &e-"
Wiinnd Eviden'ift}❑l Applicaatiioon Outside off AApprrovedArea
12. Crop Type(s): �� 0-�C�Zdoa: / . J/� -, ' `�f�-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reauuir_ed Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Tra
4No
sfers
❑ 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
No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

still Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ 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
T�
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ 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
[�] No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT��
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No [3NA ❑ 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 52 No ❑ NA ❑ NE
Comments (refer to question ): Explain any YES answers and/or any additional recommendations orany other comments.;.,:
Use drawings of facility to better explain situations (use additional onaes:as 'necessarv)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /�-33�33�0
Date:
21412011

1 ' 0 Division of Water Resources
11 Facilitylumber ®- Q Division of Soil and Water Conservation
Q Other Agency 11
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 00 Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrri/i��val Time: V Departure Time: r County: Region:
4 Farm Name: e+- C9-� '✓� Yh Owner Email:
Owner Name: PrVAW Rt4 r Phone:
Le
Mailing Address:
Physical Address: r /J
Facility Contact: �MS l.a-�-./�j Title: Phone:
Onsite Representative: N Integrator:
Certified Operator: 9,4 Certification Number: /4
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 2$
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Discharees and Stream Impacts
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Nan -La er
Pullets
Other
is
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
r-_9 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 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
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�JNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RpNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - Date of Ins ection: /
4aste 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
Z] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
T�
❑ 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
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑^ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C"'S
13. Soil Type(s): Wa l
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2} 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�) No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbmakers on irrigation equipment? ❑ Yes [5j No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

I de
Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ()Q No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �0 No ❑ NA ❑ NE
[3 Yes F] No ❑ NA ❑ NE
❑ Yes = No ❑ NA ❑ NE
❑YesNo ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
K1
..,.ii
Phone:
Date:
l/4/ZOI4

lot 4� 5
• Division of Water Quality
Facility Number EEK] - 0 Division of Soil and Water Conservation
0 Other Agency
type of visit: 4D Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
2eason for Visit: 10 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 111201109
l ' Arrival�Timer Departure Time: 9: County: SS0jMPSpn1 Region:
Farm Name: UP f kO � LT'r 9ft �. )�Pt�l T;.,eM Owner Email:
Owner Name: L46&L 'RAw Phone:
Mailing Address:
Physical Address:
Facility Contact: IZTarneS LaY IL Title:
Onsite Representative:
Certified Operator: TI n Li I
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
Latitude:
Phone
Integrator: 9 r qe
Certification Number: 1 ?1-lvk
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Discharges and Stream Imnacts
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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 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 NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
Page I of 3 21412011 Continued

t Facility Number: Date of Inspection: �1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in): _
�e
Observed Freeboard (in): q �
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 2 Structure 3 Structure 4 Structure 5
No ❑ NA ❑ NE
❑ No (��j NA ❑ NE
Structure 6
❑ Yes W No ❑ NA ❑ NE
❑ Yes W 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 [i 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 APPMeation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes `M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes jg No [3 NA [3 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs, ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):&Mal /9M•
13. Soil Type(s): MR i
14. Do the receiving chops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes jj No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes `� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes r
No ❑ NA ❑ NE
❑ Yes r@ No ❑ NA ❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Overage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Check] ists ❑ Design ❑ Maps ❑ tease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ❑NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facil1 Number: - Date of Inspection: 11 7-0
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 Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Vil No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[y3 No
T�
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. —7
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 110- 413"pp
Date: I VEEA3
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: r® Countyr. 2�on Region: R-0
Farm Name: �[ tj �- �,, p� (�Xm_ Owner Email:
Owner Name: Oi- ( i�d— CA. NCJe r� Phone:
Mailing Address:
Physical Address:
Facility Contact: e.S LaivL% Title: Phone:
Onsite Representative: r� Integrator: e
Certified Operator: S t �� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap. Cattle Capacity Pop.
Wean to Finish I I Layer Dairy Cow
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current D Cow
De, Puultt, Ca acit P.a . Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
E�PNA
❑ 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
M)NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P�;)No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
®aIo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No
Ej NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
[RNo
❑ 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
[3 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
� No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Approved Area
12. Crop Typc(s): Ccpo_�L Vy-cmu& C-,ya_as L41ay) Sm 0,ya..th Cber<�-,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E?No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes EpNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Yes 4No
❑ Yes F�5p No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No
❑ Waste Application ❑Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes PNo
[:]Yes CEPTo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili umber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RT 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
EP No
❑ NA
❑ NE
❑ Yes EpNo ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes ZP No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E'No ❑ NA ❑ NE
Comments (refer tooquestion ft. Explain,any,YES tin swers,and/or,;any "additional recommendations or anyother;comrnents
Uie drawinas of facility to bett& explain'situ atiow (use additional pages as neeesiary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Ly
21412014

I S r�l rrt
ivision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
Eel0 Other Agency
Type of Visit: M_ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
E� Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
it 4
Date of Visit: Arrival Time: Departure Time: County: 060_ Region f ! L)
Farm Name:
PC& P
i�
Owner Email:
Owner Name:
/ld /iN A,A
1)ro-9 kP
f'GfxA_' L6—Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: �.AC iJ Phone:
Onsite Representative: ` Integrator: M 0
Certified Operator: ��,A / (t r�S �^ _ _.,_.... Certification Number: 7 �a
Back-up Operator: Certification Number:
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
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Discharges and Stream Impacts
Non -La
Pullets
Other
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
1. Is any discharge observed from any part of the operation?
❑ Yes
❑- Z -'
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[Zj Ib -
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
M 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
[ZP*,k
❑ 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
E No
❑ NA
❑ NE
of the State other than from a discharge?
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 [6-Nv ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No [3-10V_ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�_Nd ❑ 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
❑- Ko - ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[D-No- ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
l cr- ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
l_T"o ^ ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P!�,M ❑ NA
[,] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10 ❑ 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 Types): c o _ ..
13. Soil Type(s): AL 6> 0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 10 �❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ZWo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [I -No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [r] ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes[!]rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3,No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps [3 Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes
l:jX
[]NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfali Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[D-No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Ins ectlon:
24.-Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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?
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:
Ct ❑ NA ❑ NE
❑'lo ❑ NA ❑ NE
[:]Yes !�" ❑ NA ❑ NE
❑ Yes EN6 ❑ NA ❑ NE
❑ Yes E2 1`'o ❑ NA ❑ NE
❑ Yes [5to ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes g No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [C'lo ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

Z
Division of Water Quality
Facility Number � - � O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:�� Departure Time: County:s IrYL M ✓ C%
CT F
Region: 15
Farm Name: �X- -�- �cw4ell W'M Owner Email:
Owner Name: C—i Row e6T Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: � integrator:
�fT+
Certified Operator: sl q O Certification Number: f S yq10
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
77+7
❑ Yes N No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
[—]Yes
[—]No
NA
[] NF
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 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 Condnued

ti
Faclli Number: Date of Ins ection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: f
LOW ❑ NA ❑ NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ 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
C] 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
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �—�70U r Y►'lLiGiet' ��'+ra! s5 �l _Z _ Itin + �}-.tt,�.�CJ ./ . .
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
Yq
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
[DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
® No
❑ NA
❑ NE
the appropriate box.
T
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes �] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

.t
Facilitj Number: Date of Ins ection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Dg 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 Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
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
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] No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
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:
ReviewerlInspector Signature:
Page 3 of 3
PRE
Phone:
Date: Z
21412011

• Division of Water Quality
'I FaciI4 Number ®- ® O Division of Soil and Water Conservation
Q Other Agency ',
(Type of Visit: 0 Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access if
Date of Visit:
Farm Name
Owner Name: Ja
Mailing Address: 6
Physical Address:
r
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title:
A If
Phone:
Integrator:
T ^ /
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
I E] La er
Non-Layer
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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)?
Design Current
Cattle Capacity Pop,
Dairy -cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes fp No ❑ NA ❑ NE
❑ Yes
❑ No
[n NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes No
❑ Yes No
�NA
ONE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412011 Continued

Facility Number: F3 jDate of Ins ection:
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 f7 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 pallo ❑ 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
t] 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
'jam
❑ 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
D No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Pg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 10 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 ❑�Elviidde�nce of ind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
e 13. Soil Type(s): W J 9
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 [F] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑ Yes 55 No ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
[:]Yes M No
[:]Yes P No
[:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214112011 Continued

[Facility Number: Date of Ins ecdon:
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 provide documentation of an actively certified operator in charge? ❑ Yes P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes V
�NA ❑ NE
OtherIssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes � No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
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 � No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes 5Q No ❑ NA ❑ NE
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 ® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes X 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).
Z c
4' I�r 4 r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0&'� q_-,749-Tti
Phone:
Date:
21412011

Division of water Quality
Facility Number 0 Division of Soll and Water Conservation -5- K2=4_:M_ U () Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 40 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Oth enled Access
Date of Visit: Arrival Time: 11.,V-� Departure Time: r 3 County: Region: FPO
Farm Name: I "' L . PoLi en Ftwm Owner Email:
Owner Name: 2Ldl
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L1'y
`11
Certified Operator: ! IBfr
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
IN Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Phone:
Phone No:
Integrator: Rz_Ss
Operator Certification Number: 6,14
Back-up Certification Number:
Latitude: 0 0 0 4 Longitude: 0 0 =1 =
it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑❑ La er -^�
Non -La er -
Other
❑ Other -- --- - --�
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: a
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 P No ❑ NA ❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

1
Z
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes F No ❑ NA ❑ NE
❑ Yes ❑ No ERNA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VYNo
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) L-Ou5`� D—rG414!yK , Crate
13. Soil type(s) wQtg
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
r�
i No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
( No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,' No
[I NA ❑ NE
i xri ar f:$# �., -. y, f !^°rr .. Px-1,3d.3^^`tr`9. 'yam<�s `y'"R }�
Comments (refer. to.question,fl EX' I in YES answers and/o"many recommendations or a;ny�other comments`
Uge drawings of,facility to better explain situakions. (usc additional pagesasneessaryr): ; w1 �,j
Qot4S r$/i q*r0
Reviewer/Inspector Name `. rli ' ' ,12 ` � 'MO phone: 2LP`3?Lv I
Reviewer/inspector Signature. Date: / pl /0
Page 2 of 3
1
Cantinned

1 �
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El 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 I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
F No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
IffNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
r2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ER No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
Q9 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
'rF) No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
)"M No
❑ NA
❑ NE
Addit�4na[ Cbntments°and/nr Drawi_ngs 4giaty
$tv.l Y a X�ai
Page 3 of 3 12128104

1
Type of Visit &C'oimpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: . j C7 Departure Time: r) County: r Region:
Farm Name: E7 (Z)' &'j16 ra ✓Pt' Owner Email:
Owner Name: i2D 01\_ pavlS Phone:
Mailing Address:
Physical Address:
Facility Contact: 0wn-- �ct.�'sS Title:
Onsite Representative: C-r�.iZ-rQ-
r�
Certified Operator:
Back-up Operator:
Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 O 0 I❑ Longitude: 00
=1 ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity apulation
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ D Cow
ElNon-Dai
❑ La ers
❑ Non -Layers
❑Pullets
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Cow
❑ Turke s
❑Turke Poults
Other
Number of Structures:
❑ Other
❑OtherI
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
C�No
❑ NA
❑ NE
12128104 Continued

Facility Number: -�gjo Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
( No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[9No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[Yes
❑ 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
[9No ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
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
allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ]bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) _ --_ ,(,,k ZG-p L6 ID ro
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
19 �IDuJ �`�5� �� o �- 6j �- /`��� r 6a•�� �,rr a d- �r�r�a��
'got
T
Reviewerllnspector Name Z Phone: O D
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: 4 — / 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 [I Maps El Other
❑ Yes XNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (�No ❑ NA El 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
E&No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
2kNo
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
2�No
❑ NA
❑ NE
❑ Yes Zio ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes CKNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
LKNo
❑ NA
❑ NE
❑ Yes
&o
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ,D Denied Access
Date of Visit: 2- Arrival Time: Lq � 004W 1 Departure Time: r� County: P-S�" Region: F�0'0
Farm Name: r.r- ' t _ , M Owner Email:
Owner Name: � a �err s Phone: _
Mailing Address:
Physical Address:
Facility Contact: _ „ , ? Title:
Onsite Representative:Q m �i"+'►
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No. -
Integrator: �S ��-,,,,,,,___
99063�7
Operator Certification Number:
Back-up Certification Number:
Latitude: = Q ❑ ' ❑ Longitude: 0 ° ❑ ' =
Design Current Design Current Design Current
Swine Capacity Population Wetip, oultry Capacity Population Cattle Cap rc ty Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑Nan -[.a Non -Layer
❑Dai Calf
Feeder to Finish
30
DairyHeifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑Beef Brood Cow
❑ Turke s
❑ Turke Poults
❑Other Number of S ructures:
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes [)�No ❑ NA ❑ NE
❑ Yes
❑ No
qNA
❑ NE
❑ Yes
❑ No
MNA
[I NE
VPNA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[} No
❑ NA
❑ NE
12128104 Continued

k
i
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): gu
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 {'ZNo ❑ 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 � No El NA El NE
maintenance or improvement?
Wa Lc A >t iicalion
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'A No ❑ NA ElNE
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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) $cts�a&212'G�6Ah
N69d
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
f� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): 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):
a
1W
Reviewer/inspector Name Phone: -5-?CO
Reviewer/inspector Signature: Date:
12128/04 Conttnued

4
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �R No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record Keeping need improvement? If yes, check the appropriate box below. ❑ Yes �3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge`?
❑ Yes
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EANo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
fR No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Efl No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
' 5 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
FINo
❑ 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
MNO
❑ 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
YINo
❑ 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
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility NumberE���]
r Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit V compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t7 Arrival Time: i A _ Departure Time: County: Region:
Farm Name: • eo rw^ Owner Email:
Owner Name: 4 4_6A_ &JC6 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:hC. Q-Q
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 4 = Longitude: 0 ° = I = „
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Nan -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
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 711
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
M NA
❑ NE
❑ Yes
❑ No
;K NA
❑ NE
0NA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
�51slo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: CAP,— Date of Inspection
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 [I NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
(PNo
❑ 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)
4. 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
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
jj
rC
12. Crop type(s) GaS 1^yy Q C-r ' Q .Sr4 i &-a, 1 OArSo.4
13. Soil type(s) LAM r0.&-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�1 No
❑ NA
❑ NE
t5. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
IS No
❑ NA
❑ NE
IT 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
Reviewer/Inspector Name _ Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

� rr
f
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rm No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps [I Other Vi
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V3 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Id No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
gg No
❑ NA
❑ NE-
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ff No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
En No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B 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
IS No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
&
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

r
w
Division of Water Quality r �;
Facility Number Division of Soil and: Water. Conservation
O Other Agency
F
f Visit � Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit $j Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ,� County: V__ Region:
It
Farm Name: Y Jl 4 �P�l �Q-U� Owner Email:
Owner Name: Phone:
Mailing Address: I
Physical Address -
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
sh
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 1 Longitude: = ° = 1 = f1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
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 MNo ❑ NA ❑ NE
I
❑ Yes ❑ No
7 NA
❑ NE
❑ Yes ❑ No
NA
❑ NE
15 WA
El NE
❑ Yes o
❑ Yes
INo
/❑ NA
ElNE
ElYeso
❑ NA
❑ NE
12128104 Continued

r
Facility Number:
Date of Inspection wNta
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):
Observed Freeboard (in):
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes ❑ No A El NE
Structure 5 S ructure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ElNE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? XYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes r
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop types) 11'y �4 e-1 ✓ o,S
13. Soil type(s)
14. Do the receiving crops differ from se designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�jNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Eros i an - &" r l,l � an h4 c k cpr ner s(P?k q U 54 re scoeA 7
rs
sew A 4-'.
Reviewer/inspector NamCAMn Ale &AlvbdQ&E Phone: cl
Reviewer/Inspector Signature: �', Date:
12128104' Continued

Facility Number: -- Date of Inspection 0
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 El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes a No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,[���qq],,
LI 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 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(9No
❑ NA
❑ NE
.
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&B 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
6 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
10 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
@No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

o�0� WAr��pc
Michael F. Easley, Governor
Vj William G. Ross Jr., Secretary
North Carolina Department of Enviranment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
December 1, 2006
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Herbert Grimes Bowden
Herbert G Bowden Farm
11294 Hobbton Hwy
Clinton, NC 28328
Subject: Application for Renewal of Coverage for Expiring NPDES General Permit
Dear Permittee:
RECEIVED
DEC 06 ON
DW — FAYERkVIIJ la RMOHAt.OMM
Your facility is currently approved for operation under one of the Animal Waste Operation NPDES General Permits, which expire on
July 1, 2007. Due to changes in federal rules, facilities that do not discharge nor propose to discharge may choose whether or not to
retain coverage under an NPDES General Permit. Copies of the draft animal waste operation NPDES general permits and the State
Non -Discharge General Permits are available at http://h2o.enr.state.ne.us/aps/afou/downloads.htm or by writing or calling:
NCDENR — DWQ Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
In order to assure your continued coverage under one of these two types of general permits, you must submit an application for permit
coverne to the Division. Enclosed you will find a `Request for Certificate of Coverage Facility Currently Covered by an Expiring
NPDES General Permit.'_ The application form must be completed and returned by January 2. 2007. Please note, you must include
two 2 copies of your most recent Waste Utilization Plan with the application form.
Failure to request renewal of your coverage under a general permit within the time period specified may result in a civil penalty.
Operation of your facility without coverage under a valid general permit would constitute a violation of NCGS 143-215.1 and could
result in assessments of civil penalties of up to $25,000 per day.
If you have any questions about the draft general permits, the enclosed application, or any related matter please feel free to contact the
Animal Feeding Operations Unit staff at 919-733-3221.
Sincerely,
6
Ted L. Bush, Jr., Chief
Aquifer Protection Section
Enclosures
cc (w/o enclosures): Sampson County Soil and Water Conservation District
Fayetteville Regional Office, Aquifer Protection Section
AFO Unit Central Files - 820186
Prestage Farms Inc
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internet: www•ncwatgguality.org Location: 2728 Capital Boulevard Raleigh, NC 27604
An Equal QpportunitylAffirmative Action Employer— 50% Recycled110% Post Consumer Paper
Telephone:
Fax 1:
Fax 2:
Customer Service:
Nam` Caro ina
(919) c! vu�ATall#I
[phone]
[phone]
[phone]

�:Ro - APs
WASTE UTILIZATION PLAN
----------------------
Producer- - ._.. : He.r}r ert Bowen County : Stamp
Name of Farm -:Herbert Bowen cyp2' 1db
Location-----:11.294 Hobbton Hwy
Clinton NC 28328
Phone -------- :910-594-1608
Type Operation -------------
Number- of Animal -- ----------: 2880
Storage Structure ---------- :,Anaerobic Lagoon
Method of application ------- :I.rrigration
Amount of waste produced per year ---------------
Amount of plant available N (PAN) produced/year-:
n DEC 2 B ZOOS
DW- FAYETiEVf LLE REGIONAL OFFICE
5472 tons/year
6624 lbs./year
The waste from your animal facility must be land applied at a
specified rote to prevent pollution of surface water and/or
groundwater. The plant. nutrients in the animal waste should be use
to reduce the amount of commercial fertilizer required for the
crops in the fields where the waste is to be applied.
This waste utilization plan uses nitrogen as the limiting
nutrient. Waste should be analyzed before each application cycle.
Annual sail tests are strongly encouraged so that all plant
nutrients can be balanced for realistic yields of the crop to be
grown.
Several factors are important in implementing your waste
utilization plan in order to maximize the fertilizer value of the
waste and to ensure that it is, applied in an environmentally safe
manner:
I. Always apply waste based on the needs of the crop to be grown
and the nutrient content of the waste. Do not apply more
nitrogen than the crop can utilize.
2. Soil types are important as they have different infiltration
rates, leaching potentials, cation exchange capacities, and
available water holding capacities.
3. Normally waste shall not be applied to land eroding at more
than 5 tons per acre per year. Waste may be applied to land
eroding at 5 or more tons per acre annually, but less than
10 tons per acre per year providing that adequate filter
strips are established.
4. Do not apply waste on saturated soils, when it is raining, or
when the surface is frozen. Either of theme conditions may
in runoff to the surface waters which is not allowed under DWQ
regulations.
5. Wind condit.ionz should al8o be considered to avoild drift and
downwind odor problems.
6. To maximize the value of the nutrients for crop production and
to r.•educe the potential for pollution, the waste should be
applied to a growing crop or applied not more than 30 days
prior to planting a crop or forages breaking dormancy.
Injecting the waste or dishing will conserve nutrients and
reduce odor problems .
This plan is based on the waste application method shown above. If
you phoose to change methods in the future, you need to revise
this plan. Nutrient levels for different application methods are
not the same.
The estimated acres needed to apply the animal waste is based on
typical nutrient content for this type of facility. Acreage
requirements should be based on the waste analysis report from
your waste management facility. In some cases you may want to have

Herbert;. Bowen
plane analysis made
applied. Prc►viaion4
be flexib3 e. so as t
and the crop type.
optimum range for s
This waste ut.i1i2
requirements for cc
Environmental Manag
YOUR WASTE UTILIZAI
J1f ew ()Jup
Page 2
. waste to be
eceiving waste to
►nalysis content
iin pH in the
►eta the
.7 adopted by the
)WING:
Tract
Zone' Suit Crop
Yield
Lbs. N Acres
Lbs. N Month to
No.
No. Type Code
/!Acre
/Unit
Used Apply
10558
1A WaB C
5.5
50.00 3.20
880 MAR--AUG
10558
2A WaB C
5.5
50.00 3.42
941 MAR-AUG
10558
1B WaB C
5.5
50.00 2.11
580 MAR--AUG
1.0558
2B C
5.5
50.00 2.37
652 MAR-AUG
10558
1C WaB C
5.5
50.00 4.30
1183 MAR-AUG
10558
3 WaB C
5.5
50.00 1.34
369 MAR-AUG
10558
4 Wail C
5.5
50.00 1.03
283 MAR-AUG
10558
ALL WaB L
N/A
100.00 *17.77
1777 S-0,F-M
Total 17.77
6664
Available Nitrogen
(includes commercial)
6624
Surplus Or Deficit
-40
Crop codes: Crop -unit
A=Barley-bu.
I=Oats-bu.
B=Bermudagrrasa(grane)-tans
J=Rye-bu.
C=Bermudragraaa(hay) -tones
K=Small grain(graze)
-acre
D=Corn(grain)-bu.
L=Small grain(hay)-acre
Morn(silage)-tons
M=Sorghum(grain)--cwt.
F=Colston- lbs . lint
W =Wheat-bu .
G=Fesc.ue(graze) -tons
Y=Fescue(pasture)-tons
H=Fescue(hay)--tons
Z=Bermudagrass(pasture)--tons
Applying
the above amount of
waste
is a big job.
You should plan
time and
have appropriate equipment
to apply the
waste in e timely
manner.

Herbert Bowen Page. 3
The applicator is cautioned that is and K may be over .;applied while
meeting the N requirementa. In the future, regulations may require
farmers in some parts of Borth Carolina to have a nutrient
management plan that addre.;ssees all nutrients. This plan only
addresses nitrogen.
In interplanted Fields (i.e. small grain, etc, interseeded in
bermudagr^ass) , forage must be removed through grazing, hay and/or
silage. Where grazing, plant; should be grazed when they reach a
height of six to nine inches. Cattle should be removed when plants
are grazed to a height of four inches. In fields where small grain
etc, is to be removed for hay or silage, care should be exercised
not to to let small grain, to reach maturity, especially late in
the season (i.e. April or May) . Shading may result if small grain
gate too high and this will definitely interfere with stand of
bermudagrnss. This loss of 8tarid will result in reduced yields and
less nitrogen being utilized. Rather then cutting small grain for
hay or silage ,just before heading as is the normal situation, you
are encouraged to rut the small grain earlier. You may want to
conaider harvesting hay or silage two to three times during the
season, depending on time small grain is planted in the fall.
The ideal time to interplant small grain, etc, is late September
or early October. bril.ling is recommended over broadcasting.
L'ermudegrass should be grazed or mowed to a height of about two
inches before drilling for best. results.
Caution must be exercised in grazing or haying summer annuals
under streaaed conditions. Nitrate poisoning may occur in
livestock. .Sampling forage or hay for nitrate levels is
recommended.
Acres shown in the tables are considered to be the usable acres
excluding required buffers , filter strips along ditches, odd
areas unable to be irrigated, and perimeter areas not receiving
full application rates due to equipment limitations. Actual total
acres in the field listed may, and most likely will be, more than
the acres ahown in the tables.
Seer attached map showing the fields to be, used for the utilization
of animal waste.
SLUDGE APPLICATION
The waste utilization plan must contain provision for periodic:
land application of sludge at agronomic rates. The sludge will be:
nutrient rich and will require precautionary measures to prevent
over application of nutrients or other elements. Your production
facility will produce approximately 1037 lbs. of plant available
nitrogen per year in the sludge.
If you remove sludge every 5 years, you will have approximately
5184 lbaw of PAN to utilize. assuming you apply this PAN to
hybrid bermudagr as& hayland at the rate of 300 lbs. of nitrogen
per acre, you will need 1; ac:rea of land. If you apply the
sludge to corn at the rate. of 125 lba. of nitrogen per acre, you
will need 41 acres of land. Please be aware that these are
only estimates of the PAN :and land needed. Actual requirements
could very by 25% depending on your sludge waste analysis, soil
types, realistic yields, and application methods.

Aerbert Bowen Page 4
,APPLICATION OF WASTE BY IRRIGATION
P The irrigation application rate should not exceed the intake rate
of the toil at the time of irrigation such that runoff or ponding
occurs. This rate is limited by initial sail moisture content,
soil structure, ,soil texture, water droplet size, and organic
solids. The applAc:ation r-mount, should not exceed the available
water holding capacity of the moil at the time of irrigation nor
should the plant available nitrogen applied exceed the nitrogen
needs of the crop.
If surface Kwigation is the method of land application for this
plan, it its the responsibility of the producer and irrigation
designer to ensure that an irrigation system is installed to
properly irrigate the acres shown in tables. Failure to apply the
recommended rates and amounts of nitrogen shown in the table may
mare this plan invalid.
The following table is provided as xa guide for establishing
application rates and amounts.
Tract Zone Soil Crop ,Applic Applic IRR-2
No. No. Type Rcte. Amount PAN
Cin/hr) Cin(s)) LBS/AC
10558 All WaB CB -MAY 0.6 0.96 275
10558 ALL WaB SG -}-SAY 0.6 0.96 100
This is the maximum application ,amount allowed for the soil
assuming the amount of nitrogen allowed for the crop is not over
applied. In many situations the application amount :shown cannot be
applied because of the nitrogen limitation. The maximum
application amountshown can be applied under optimum soil
conditions.

Herbert Bowen Page 5
Your facility is designed for 180 days of temporary storage and
I the temporary etorage must be removed on the average of once every
6 months. In no instances should the volume of the waste be stored
in your structure be within the 25 year. 24 hour storm .storage or
one foot of freeboard except in the event of the 25 year 24 hour
storm.
It is the responsibility of the producer and waste applicator to
ensure that they spreader equipment is operated properly to apply
the correct rates to the acres shown in the tables. Failure to
apply the recommended rates and amounts of nitrogen shown in the
tables may make t.hiz plan invalid.
Call your technical specialist after you receive the waste
analysis report for assistance in determining the amount of waste
per acre and the proper application rate prior to applying the
waste.
NARRATIVE OF OPERATION
Cereal Rye should be planted by October 15. The last application
of animal waste is to be applied to the bermuda prior to August 31
An application of 50 lbs/ac of (PAN) may be applied between
September 15 and October 30. An additional 50 lba/ac of (FAN) may
be applied in February -March. A harvest is required prior to
heading or April i, which ever comes first.
E

Page 6
WASTE UTILIZATION PLAN AGREEMENT
Name of Farm: Fi,-:�rbert Bowen
Owner/Manager Agt•t�:ement
I (we) understand and will follow and implement the specifications
and the operation and maintenance procedures established in the
approved animal waste utilization plan :for the farm named above. I
(we) know that any expansion to the existing design capacity of
the waste treatment and storage system or construction of new
facilities will require c, new certification to be submitted to the
North Carolina Diviaian of Water Quality (NCDWO) before the new
animals are stocked. I (we) also understand that there must be no
discharge of animal waste from this system to the surface waters
of the state from a storm event legs severe than the 25-year, 24-
hour storm. The approved plan will be filed on -site at the farm
office and at the office of the local Soil and Water Conservation
Diatrict and will be available fox- review by NCDWQ upon request.
Name of Facility Owner: Herbert Bowen
(Please print)
j Signature:
Name of Manager(If different from owner) :
Signature: Date:
Name of Person, Preparing Plan:
(Please print:)
Affiliation: Prestage Farms, Inc.
Address P 0 Box 498
Clinton NC 28529
G. Glenn Clifton
Phone: [phone]
Ext. 249
Signature: �'-�a.....-- CL`'Q ��'ti' _ Data: 3 f Z+ 10
u —

S,
ate•1 7
I n—
_oZ
Dims

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: + D- 3 Arrival Time: . 10 Departure Time: e? % County: SD Region': r O
Farm Name: &W je F'L M Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: �P�s
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = = it Longitude: 0 e = , = 4i
Current
Design C►urrent
Design Current
111Nmesign
Swine Capacity
Population
Wet Poultry Capacity Population
C►attle Capacity Population
❑ an to Finish
❑ La er
❑ Dairy Cow
❑ an to Feeder
Layer
❑ DairyCalf
Feeder to Finish
0
3 a
❑ Dai Heifer
❑ Farrow to Wean
Pou ltry
❑ D Cow
Elpry
Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
on -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
ther
Number of Structures:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
El Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[PNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
O NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[�PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 No
❑ Yes No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes N No ❑ NA ❑ NE
❑ Yes NNo ❑ 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 allo ❑ 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? 444
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA ❑ NE
maintenance/i mprovement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1� No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [:1 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ]bs ❑ 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) 0qa sw
13.
Soil type(s) rhf h
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
19 No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
10 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments. - • A'`x
Use drawings of facility to better explain situations. (use additional pages as necessary):
I
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: /Q .3�
Page 2 of 3 12128104 Continued

67-1
Facility Number: 9L--( VD I
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EpNo ❑ 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 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
21 Did the facility fail to install and maintain a rain gauge? ❑ Yes PNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej4No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E!�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
rNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E] 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
ERNo
❑ 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
�0 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
IMNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
ElNE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Asslstance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 5 zt o7 Arrival Time: 1 •3 Departure Time: County: SQ,..�o rJ Region: %mod
Farm Name: _ r J b c, -�- a P _ Owner Email:
Owner Name: Pr r-Z:. A -a P ca ,� Q Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: b o Integrator: PIr c.� 4- a 4 Cr
Certified Operator:Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 =ig Longitude: = ° = g =
it
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish .2514-0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars i
Other
❑ Other
❑ La er
❑ Non -Layer
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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
[B No
❑ NA
❑ NE
[IYes
d No
❑ NA
❑ NE
12128104 Continued

>'acility Number: $ ? — /&G Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure d
Identifier: 1
Spillway?:
Designed Freeboard (in): tea, G 3 la e / 9.1
Observed Freeboard (in): a 7,"
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 ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of
Area
12. Crop type(s) . &,
13. Soil type(s) lin
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Reviewer/Inspector Name" =c°Aa j���`°ay`
,,�. �,..,,,,.�„ Phone:
Reviewer/Inspector Signature: Date: -5'/ 911
12128104 Continued

Facility Number: $'� — j�tr Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 I. 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
El Yes El No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes ❑No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No El NA ❑NE
[I Yes ❑No [I NA ❑NE
Ia[I)tti0[It1}'Comments'andlo'r`Drawin S
V c lr S cK i-j G J Y G - i- o V G oQ
L, b W Oir LC� i *, S {� rd Gi�
! � W0,NCr4vl+5 Ge.u-4-CUr� ��r�.►�q
.12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit O Routine O Complaint O Follow up O Referral O Emergency 16Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 5 ar.,4ma" Region: P'►zA
Farm Name: l--e-ir 12 d..sORC-INQ _ �d r w. Owner Email:
Owner Name: Pr .S-k 4 a 1 G a be Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: e- tj __ r i +•I-__
Certified Operator: -e jc: :
Rack -up Operator:
Phone No:
Integrator: Qr
Operator Certification Number: Li
Back-up Certification Number:
Location of Farm: Latitude: = e =' 0 " Longitude: ❑ ° 0' 0 "
Dgn
Swine Capacity
Current
,.Fopu�latian W,et Poultry
Design Current
Capac ty Population
Cattle
Design Current
Capacity Population
❑ Wean to Finish
❑ Layer
I
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
❑ Non -La et
® Feeder to Finish
1.2R80
I
Dry Poultry
❑ Dairy 1•leifei
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Farrow to Finish
milts❑Non-La
ElNon-Dairy
El
Layers
❑ Beef Stockei
❑
ers
❑ Beef Feeder
Pullets
❑ Boars
❑ Beef Brood Cow
umber of 5tructures:
I
Other
❑
❑
Turkeys
Turke Poults
❑ Other
JEI
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
[4 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

71
FaciNty Number: fa — B Date of Inspection 7/4-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 ❑ No ❑ NA [Z NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No [:1 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 JR] NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA lj� 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 0 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[--]Yes' [--]No
❑ NA
® NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[7 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
❑ No
❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Comme�nts(refer�to questions#) �,Expin�ln�any� YES answers,aad�lo�r�any�recomenenda�t[ans or any other comments.
Use drawia�safnfaciiity. ta�bettepr°explalnGsituations�s(wse adcEitipnalNpHages,,a� necessaryj;
Reviewer/Inspector Name_..__ ��
- c - — [ . F :� s �. ,.:; _ j �, _ Phone:
Reviewer/Inspector Signature: Date:
Connnuea

r Facillity Number: S.7 Date of Inspection S/as os
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA rA 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 El Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[K NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
® NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
w NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
P NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
.0 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[W NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
(M NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ® NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
4 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
I3'NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
Dd NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[N No
❑ NA
❑ NE
Additional Codimenfs and/or 1
�Y+ 4V11'�4 �a-i L`` a, ��MY'tq�^%t4h evtrt Wa.� sv% ler0�rGSS ar%
GL ptA\\ C,\CJ-r._
W C_0+L% tv L+7 a Y'ov i -I i +L}p Vi. 4Y Gq a�r� cad :1- e.,t s COw•�'►
0; et itvak«Q w`.v.oQs ar.o� pvss�i.�t �+Gav
� r ct h •�. o-r r a v.'C ed� Ca.v.�1 U`a 1\ .
IM Ir. 13. w a i r e s c kk 4 1Iv% a� S o da -� cdQ k a oSZ a V h^�ta.Qt{ S +► K ..
CROW&% 0 V% I uN oQk G -Fo +1kc. a t I1-4 t-,2 o /+C.0 n CCYwjs , 1 � c- rc,
waa w•0,,�y.�
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G�vL�i i��01J,j W CrG av n'��t6 fie,
12128104

r
IType of Visit 0 Compliance Inspection p Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification p Other
❑ Denied Access
Date of Visit: _ .� 17 Time: 8 ' �
Facility Number 8J- G
0 Not O erational Q Below Threshold
ermitted �rt�ed 13 Conditionally Certified Cj Registered Date Last Operated or Above Threshold: .........................
Farm Name: ... Ha,6.ecL.....6........ &W.. aife%i............J.r4s..ah......................... County:.....�u h�?.�f11..................................r.4.0.....
Owner Name: .................. Hex.jej_� .......... vY!F!tn................................................. -Phone No:....rl �V.. ..ter-y ... ���:a�..................................
MailingAddress:..t✓�.0 �7�1........ .........t�{� gfj.W.:c.�r........ .................................... I............... ..........................
FacilityContact: ............. ........ d0.V.rr!'Cri............ Title; ................................................................ Phone No:...................................................
Onsite Representative:...........n..Qi1 G�lx.►................................................ Integrator: ...... G.(.-eaX�.fL .................. ..................................
Certified Operator: ...... a.4.k49.x...........,1,:?�:]wklexa................................................. Operator Certification Number:........ e / R..............
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 9d
Swine
>: .il^45P=1.7iIF:E'�1'�i`�i.,\dR
❑ Wean to Feeder;
R4�y 17Eil
�ilV filR\iV��B
'dFE-1,-.-'e'JF.
3Il.lf�1„E:,
❑ Layer
AV" "I M✓ Ie1.V
YIWMVNII
C3Teeder to Finish
79g pg#o
?
❑Non -Layer
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
➢r j!SIEd �ia�
c''I 11 t f1TT Y'3) li'i�l4 E -J"
�' ! �+�
Ie?'���4 �' � �.l"N �1
[3 Gilts
.+ Is €' r lire u�`i EFL.! El3�IF': i
P ir, IIE�� IIDA
d�4
Al�F�°,i j 5! a tl 1't
ELi
❑ Boars
E
t: 1; ti y ,
i 1,1 � gel ' Iie51�r1 r r"F CL1rre1rlt �,
f: tlCettleEt -il E .. CCai aC; 'tob Illation !;
fI
❑ Dairy
❑ Non -Dairy
1 r"
�
la
VV e t`
`Sn.�L.vd���.
=t, Number,of�Lagoonsf;j a�'
Is
.'-
s,l
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
0-No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ yes
MV6
c. If discharge is observed, what is the estimated flow in gaumin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
QN-0
2. Is there evidence of past discharge from any part of the operation?
❑ yes
[,io
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
Q-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
0-�fo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure b
Identifier: .. ............ I................... .............................................................................................................................................
................. I.................
Freeboard (inches): 3S
12112103
Continued

Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑. 6
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2'110—
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? ❑ Yes EM
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 04<0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [j Yes [}No "
elevation markings?
Waste AnollCfrtion
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9-Ko
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [moo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crap type,, r re%a �. /tom f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 3 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑-No
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes [.- No
I5. Does the receiving crop need improvement? ❑ Yes mi<o
16. Is there a lack of adequate waste application equipment? ❑ Yes Eallo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes U-No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑-No
Air Quality representative immediately.
i tL _ ,ir ' S r'il `^f 1 ,,;1 ; 4 SYr ! ^ . � J l " -«T„ ,#k. _ >, _ ....
�Comments3(refer�ta lquestlain'#) �F.ycplatn ai°y YESfa�nswers and/or any recommendations.oriany other comiimen
ecessaryts 3 ''
Use drawings'oi facility to Better explrun situadaas (use'additaonallpages as n)°i, wield Co ❑ ry Final Notes a "!j 3 pp at. pt= a��i{ Fir y� p I�l1»t�L l•}.� >� z f 1� r "'��'h �3 I Ir r;:. —�) i-;3 i. i i l: 3k§! 11 it � � � � �t _ 5 I 1.,,, 1 7.,. r- I.. F py
."�€ro?.4 = ..t, k. .ir !,I�3 i.,s[i"Irtltr �. ;�� i�r �iii ��at���l�E_.�.�di �'.ktiP.i�;l�}��z .,a!_?aa_°i?.i3�.:: ..�s�s �'.�-sl. tEi.;'�a,..:��st�'�.'.3. .. i.�..3:: i1.El�i.e.... ...>>�: u; i.er. :J.,' .�`=�:.F`."'r� �`�•t. �R:r=y l.s._.. �.'�ir'�..� .'.�-..
FGr on tills oved Aeesle s.
Fwrm ,,s well 1(e/11
141`, +oawolfn A&a C4411I9,,1 hGS
aov4 fl'-014 4rj
n
C ko,9eol % 4s rye fv u l (Uo /( '�o/""
` J oc.�o6Pi+
No.. Pu'"Pf^y �uS Dee, dohe sfrn[� D003,
/ins ect Name
E r-r
Reviewer OC
p
�f
Reviewer/inspector Signature: Date: M3 -31-0N
12112103 Continued

Facility Number: 92-1gloDate of Inspection
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[-NO'
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
U-No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
amo­
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling—"
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑W6
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
G-W
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
E;,No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
GWb
28.
Does facility require a follow-up visit by same agency?
❑ Yes
UNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑-eft•
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑'Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
QNo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2<o
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
RNO
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
04o
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
2 No
❑ Stocking Fo ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspectiong 6 Annual Certification Form
12112103

F�;s {�5.
Farm N
Mailing
County
Integral
On Site Representative:—
Physical Address/Location:
' Site Requires Immediate Attention: _iO
Facility No. ai
DIVISION OF ENVIRONMENTAL MANAGEMENT Ste'" �374,
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: '7 , 1995
Time: 3 Od'
_ Phone:
Type of Operation: Swipe Poultry Cattle
Design Capacity: �� _ Number of Animals on Site: 14 49_� 7,Z1—
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: _Ft. _„`Inches
Was any seepage observed from the lagoon(s)? Yes ok�pWas any erosion observed? Yes or -
Is adequate land available for spray? �or No Is the cover crop adequate? Ye or No
Crop(s) being utilized: C- -I-, izw _ cE�e5 Co ng_14 V= �
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ni or No
100 Feet from Wells? CQ or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes orb
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(Q
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(D If Yes, Please Explain.
Does the facility maintain adequate waste management recor s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? r No
Additional Comments: 4--- S ks,
Inspector Name.
Signaiure
cc: Facility Assessment Unit Use Attachments if Needed.

b
e . i
MOATS GAROLnM DXPART!!= OF ENNVIAOMMMT, EBALTR 6 NATURAL RESOURCES
DIVISION OF ENMOPIIHENTAL NANAGZMMT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
•,�!.ir+ a� i. b^.�:'M�r..^ii .pdo1^.", �, }�Y �. •�''1i �5^` 4
.a,r � ..:whil r.-v�.v, l iYj:we.iw,s',.��k. w y.. vim. n r9 :,
rIrISpF.Q'ION' ;--IDBTE
Herbei-t Bowden
�,.1. ,. Y.FF• MY T.4T^:�'nF:,.:...«�yS^^}}��'��Y��.✓jjF��++IQQ � % I yy 4
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Rt 3 Box 205 Ckrnbn NG 22328
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All questions answered negatively will be discussed in sufficient detail in
the'Comzents Section to enable the deemed 8ermittee to perform the appropriate
corrections;
s>rcTia� �
Anim81 02aratIM TM►: der Fi n,� sh
Horses, cattle swine poultry, or sheep
SEGTIM ,IT
Y I N I CalDYTS
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
systam) 3
2. Does this facility meet criteria for
Animal Operation REGISTRATMN?
3. Are animals confined fed or maintained
in this facility for a 12-month period? -
4. Does this facility have a CERTIZIM
Emig G
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
G. Does this facility meet the 5CS minimum
setback criteria for neighboring houses,
wells, etc?

P&eld -Site Management
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USCS
Map Blue LiAe Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land appiication'site have a
cover crop in accordance'with the
CZR FIQLTXQN FLAPP
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6. noes the animal waste management at this
farm adhere to Best Management Practices
(SMP) of the approved _MTTFIQ&TION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately )
B. is the general condition of this CAFO facility,
including management and operation,
satisfactory?
NggzON -?y
gom- ment5

REGIS7RA?:ON FORM FOR ANIMAL F_,CLOT O?ERAjI0N5
Oepartmenc of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of - cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are -served by
a liquid waste system, z.hen this farm must be filled cut and mailed
by December 31, L993 pursuant tc 15A NCAC 2H.0217 (c) in order to'be
deemed permitted by OEM. ?lease print clearly.
Farm Name: f7lhf(_L-
Mailinc Address:
County:
Owners) Name: &6FLZ4
Manage; (s) Name:
Lessee Name:
Farm Location (Be As specific as
ble: road names, ection,
milepost,. etc. ) X",/wflL 0'f_ �/ �?c7.'l �z,a,aAl
Latitude/Longitude if known:[�J Cf� f 1
Design capacity of animal waste management system (Ner and type
of ccnzined aninal (s)) :`?4C� ��E�F� +tom _1-"/11�s
Average anima' population an the farm (Number and type of animal (s)
raised) �',rr,E-�
Year Production Began: ASCS Tract No.:,5„_
Type of Waste Management System Used: °r '
Acres Available for Land Application of Waste- 2 3 As- Q^z= `t C-
Owner (s) Signature (s) :_­o
DATE:
j�.3