820188_INSPECTIONS_20171231

1 14
NORTH CAROLINA
Department of Environmental Quai

t iype or v isit: VA--ompuance inspection v uperation Keview v jtructure Evacuation U ieenntcat Assistance K'
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access ' i^
Date of Visit: Tc Arrival Time: c t} Departure Time: t 0 County: S /V Region: rl Z53
Farm Name: r`V''L i Owner Email:
L
Owner Name: Phone:
Mailing Address:
Physical. Address:
Facility Contact: �c� + 5 Sad` Gv t'CC Title: Phone:
Onsite Representative: LC ! / Integrator: 14 A7—S
Certified Operator: a X,4A-t-S ``�tti`G[ O �'�I Certification Number: l K7 ^
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish ?S 3 f�
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D P.oultr,
C•a aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ NA ❑ NE
❑ Yes
❑ No
C'NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
❑'l fZA
❑ NE
❑ Yes
D—No
❑ NA
❑ NE
[]Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facile Number: W 10 jDate of Inspection:
Vliaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [3-r6_ ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes [:]No E]AX—[-] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
�] N�
❑ NA
❑ NE
waste management or closure plan?
��
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑.PAS'
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[- to
❑ NA
❑ NE
(not applicable to roofed pits, &y stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Pa No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2<0 ❑ 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):kG {.� �-C, S� tq
13. Soil Type(s): �o N d
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [D'No (] NA E] 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
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 [D'lq'o ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes ❑'iQo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'hlo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [],Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0'9 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ESNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacilk Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q' o_ ❑ 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 D-Ro ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the 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?
epy; rL3 answer
to
. �� ,,,., �-t sf 1C 5C�_
CAI Rlv�
ReviewerlInspector Name: ' U t�Jl1
Reviewer/Inspector Signature:
Page 3 of 3
al
yes as necessary).
❑ Yes C�-Wo ❑ NA ❑ NE
❑ Yes ❑-ITo— ❑ NA ❑ NE
❑ Yes CB o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes EDI o
❑ Yes F lvo
❑ Yes F No
ons or any other co
❑NA ❑NE
❑ NA ❑ NE
❑NA ONE
Phone: ,f A,-333
Date: 5 �-" 1
21412015

ivision of Water Resources
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: er outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a7 Departure Time: County: Region:,F��
Farm Name: F W/j - Owner Email:
Owner Name: l'[�W �jt`C. Phone:
Mailing Address:
Physical Address:
Facility Contact: (_L,w�`�j /,,,,cam Title: Phone:
Onsite Representative: < < Integrator:
Certified Operator: [ ✓1 as Certification Number•
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes g--N ❑ NA ❑ NE
❑ Yes
[] No
EffMA
❑ NE
❑ Yes
❑ No
D-57�
❑ NE
❑ Yes
❑ No
C3 NA
❑ NE
❑ Yes
2"No
❑ NA
❑ NE
[] Yes
La"No
❑ NA
❑ NE
Page I of 3 21412015 Continued

hacilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�Aie--E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes- ❑ No �A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[: 3Xo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Ej IN
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[f]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
2--No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a'1Qo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2-1�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): tir�QII (� O G%t�,C3
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? ❑ Yes [ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes r;Mo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZlNo
❑ 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 WTo
❑ 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 ZNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I Facilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E '-M ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ET'�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
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
ETNo
❑ NA
❑ NE
[-]Yes
E No
❑ NA
❑ NE
❑ Yes 2<0 ❑ NA ❑ NE
❑ Yes [noNo ❑ NA ❑ NE
❑ Yes
[D'N'
❑ NA
❑ NE
❑ Yes
2-55­
❑ NA
❑ NE
❑ Yes
No
❑ Yes
[2Ko
[]Yes
P-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Cemments.(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).
CAJ (b r4�, - F- rr (�
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone.
Date:
21412015

' ru0Gi _ ( 6 i3 Q
Type of Visit: El -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: GKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Id
Date of Visit: I i 1� Arrival Time: 0 Departure Time: County:
_1
Farm Name: �' 't Owner Email:
s
Owner Name: Phone:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Integrator:
Phone:
At
Region
Certified Operator: ''6 Certification Number:
Back-up Operator: 11
4,` 604- l G�- Certification Number: C 0-7
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Yop. Wet Poultry Capacity Pap.
Design Current
Cattie Capacity Yop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
D.r, P■oultr. Ca aci P■o
Layers
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
LTHTurkeys
Non -Layers
Boars
Other
Other
Pullets
Turke Poults
Beef Brood Cow
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[]Yes NA ❑ NE
a. Was the conveyance man-made? [:]Yes [:]No WN_A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [] No 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 F3/No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility umber: rLY, - Date of Ins ectlon:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[a -no
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[ A
[] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
[2Ko
❑ 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 environment threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
❑ YesVNo
❑ Yes
❑ NA
❑ NA
❑ NE
❑ 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
ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Vf No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes ONo ❑ 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
1-'
12. Crop Type(s): ew,',
13. Soil Type(s): aiV'o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Er To ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes F:10'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E2-lqo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? [:]Yes hio ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [3No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [310 ❑ 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 []4o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

li ecili Number: jDate of Inspection: tG�.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E .Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ga- ❑ NA ❑ NE
the appropriate box(cs) 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Rio
❑ 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
[2<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
El"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
[7 jNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
21412011

I WS C(-3 0 -1 s (3-b
* ivision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: QJ26mpliance Inspection Q 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: U Departure Time: County: M Region
Farm Name: (f�i,V ��J� - Owner Email:
Owner Name: f'f10n l 4P Fa J1r r . i( Phone:
Mailing Address:
Physical Address:
Facility Contact:
c"La', 1 ay-c k Lk Title:
Onsite Representative: �I
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: ! q
Certification Number: / f V_ 7
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
ury rourtr
Layers
Non -Layers
Pullets
Turkeys
Turkey Pou
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0,o ❑ NA ❑ NE
E] Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑3<0
[-]Yes 2-<o
❑-KA_ ❑ NE
D-N-A ❑ N E
[] NA
❑ NE
❑NA
❑NE
❑NA
❑NE
Page I of 3 21412011 Continued

rh`acility Number: - Date —of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [2,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 ED-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
Ej<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Qg-Mo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C:[,6
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E]_NT
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[D"l'Vo_
❑ 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 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift`- �❑ Application Outside of Approved Area
12. Crop Type(s): „... ,_ — e� S� C) Gc �
13. Soil Type(s): 0 n IV D
W. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[21No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3 o
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
❑14o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[DNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0' o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D<O ❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Nacili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ICN° ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C;[4- " ❑ 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 structurc(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
ego ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E�-Ko ❑ 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
Q-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
�10 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo ❑ 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 ex' lain'situations (use additional ages its necessa ,}
Ca( X� r-,4 I'D &A
�W-- eJ C9
Reviewer/Inspector Name: Phone: 33
t
Reviewer/Inspector Signature: t Date: • ' {t�
Page 3 of 3 21412014

ivision of Water Quality (�
Facility Number 0 Division of Soil and Water Conservation ����,
0 Other Agency
Type of visit: CF—Co H nee inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Com Taint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: :-7County: !%2X1-- -
Farm Name: �,-�,rn r �haG� Owner Email:
Owner Name: CdJQyrd � � Phone:
Mailing Address:
Physical Address:
Facility Contact: �1 a ��— Title:�C%FI,�
Integrator: eg�,--
1001,
Certification Number:
Region:
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
Latitude:
Phone:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Q Nan -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[:]Yes 5INo
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

• Facili Number: T - Date of Inspection: —13-
13
Waste Collection & Treatment
'. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
RNo
❑ 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
QNo
❑ 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
2,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M�N0
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Z_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ 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 Approved Area
12. Crop Type(s): L&-'- a01 �I%y ��r-� � � ,! .. �
13. Soil Type(s): bX
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes JR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JZ 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 [R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C&No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [SLNo
❑NA ❑NE
❑ Weather Code
[:]Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facilit Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ja 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 2] 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?
24. 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
�gNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
WNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
M 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).
s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: eoy,33:_'arft
Date:
2/4/2011

1(-—1 CTD
ivision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit: (O' Z-om 'ante Inspection U Operation Review (.) Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Tinidl== County: 9Region(��
Farm Name: VV Owner Email:
..1
Owner Name: C Phone:
Mailing Address: U-'A tL
Physical Address:
Facility Contact:
[ 0J tS i!J AV)W El Title:
Onsite Representative: I[
Certified Operator: yT 0
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
Latitude:
Phone:
Integrator: RZE
C
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Nan-L
Pullets
Other
Design Current
Ly
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
D. -W
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
p N7V
❑ 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
[f NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[E�No
[3 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

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? E] Yes � 'vo ~❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes []moo ❑ 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 D-Iqo— ❑ 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 E= o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes a -go ❑ 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 [9 N-5 ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0<0 ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E11o_
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E -Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ET15-o—
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
"o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes to ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2 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 [3 Monthly and 1" Rainfall Inspections
❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
gNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
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(cs) 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)
UD-M [DNA ❑ NE
Q'N—o— ❑ NA ❑ NE
❑ Yes [ZWo ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes r/_1.? c ❑ NA ❑ NE
❑ Yes 3<0 ❑ NA ❑ NE
❑ Yes ❑11o_ ❑ NA ❑ NE
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 E!�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
rents (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
drawings of facility to better explain situations (use additional pages as necessary).
Ca66(-+;aA 6 7-S'17
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Pao y 2 ? -�5
:
Date: lilo"P_
21414 11

(9 Nision of Water Quality
Facility Number ®- i$s O Division of Soil and Water Conservation
O Other Agency
I'ype of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: t/Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: ;t, I Arrival Time: Departure Time: j /!i County:gSq
Farm Name: f p >, _S1 Owner Email:
Owner Name: �ArnP.S M, iF9M(zCAb-1-h Phone:
Mailing Address:
Physical Address:
Facility Contact: Q u a qR V rW \<, ,._ Title :_'P_Cj a r , pA SDrcjpri Phone:
Integrator:
Region: FAO
Onsite Representative: P-
Certified Operator: p S V\, ramac- _\C \
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:
Certification Number: 19R-27
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Discharges and Stream Impacts
ury_rouitry
Layers
Non. Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
DaiEX Cow
Daia Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
I. Is any discharge observed from any part of the operation?
❑ Yes
[Z'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[SfNA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
[] No
�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[+f NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[Jf No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
(ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

j
Facili Number: "a - Date of Inspection: '-i' �L,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [21 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No EDINA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �_L
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 E3"N' o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmentai threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E3"'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ff "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 [2"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [Z"No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Dlf4o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):—I OA (drP k
�GR!+,� 1's.t''-C}• . CoQ,r`. \31,LAA;S Qtl� bP Ap
l3. SoilType(s): O -ado 0a&Ro1j6.„b a, 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff 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 ❑ Yes [�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[L?Io
❑ NA
❑ NE
Required _Records _& _Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2'0No
❑ 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 ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EyNo
❑ 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? ❑ Yes dNo
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
5�rNA ❑ NE
Page 2 of 3 21412011 Continued

FaciIi Number: a - J I Date of Inspection: 4a,`t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any 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 [5No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3/No
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 [2"No
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 [D/No
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 gNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
E A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [1/No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [E(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).!
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: CN3,3A Ubs1
Date:}-
2/4/2011

Q. U Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: =Outine
ante Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: �� Departure Time: � County:
3.1
Farm Name: F. Li Owner Email:
1}- b l�
Owner Name: �J A'rv�-�S � G+.-1 �r't- Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: &4LS I..J&A-W f (. itle: Phone:
Onsite Representative: �p > Integrator:
Certified Operator:Certification Number: —8
Back-up Operator: Certification Number: r ! Fa
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Laver
Non -La er
Fou
Non-L
Pullets
Other
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)
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 -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ta ❑ NA ❑ NE
[:]Yes
❑ No
2 A
❑ NE
❑ Yes
[:]No
[2011A
❑ 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 [ Rio
❑ Yes [2Vo
[2 A
❑ NE
❑ NA
❑ NE
i
❑ NA
❑ NE
Page I of 3
21412011 Continued

Facilit 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
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
E�<o ❑NA ONE
❑ No L46A ❑ 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
[ to
❑ NA
D 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
CZJ-4o
❑ 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
024
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
U21<o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
g? LYo
❑ NA
❑ NE
maintenance or improvement?
Waste ADplication
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M401
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Io
❑ NA
❑ NE
❑ Excessive Ponding ❑ 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 Win Drift 0 Application Outside of Approved Area
01
12. Crop Yp T e(s): �JJ
13. Soil Type(s). (�
14. Do the receiving crops differ from those esignated in the CAWMP?
❑ Yes
rr
2rI o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U24o
❑ NA
❑ NE
acres determination?
17, Does the facility lack adequate acreage for land application?
❑ Yes
E?'Il0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[g*<0
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Ko
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
to
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
L'A0NE
Page 2 of 3 21417011 Continued

Facility,Number: - imDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ff No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
2r'5o
❑ 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
12<0
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
lid4A" ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes K3<o ❑ NA ❑ NE
❑ Yes O NNo ❑ NA ❑ NE
❑ Yes EjeNo ❑ NA ❑ NE
❑ Yes % ❑ NA ❑ NE
❑ Yes Er No ❑ NA
❑ Yes NA
Yes�:�No,
o ❑ NA
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments Y 4
Use,drawings of facility to better explain situations (use.additional pages as necessary).
ci's I at, bs
ve�r4+—.
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signatur : Date: /-:�— / I /
Page 3 of 3 /412011

S 2-0
vision of Water Quality
Facility Number 82 / $8 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0*f�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Asslstance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z D3-/O Arrival Time: /: /S k„ Departure Time: County: -ram" so,V
Farm Name: �p r'�"' Owner Email:
Owner Name: Ta'`� �a�'►-e [o�L. Phone:
Mailing Address:
Region: F/20
Physical Address:
Facility Contact: Cur+' s 11.wwlcA Title: 7--c,4. $PAC ' Phone No:
Onsite Representative: Integrator: a t'%Gv1 r-
Fay-
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm;
Swine
Latitude: [= o = 6 Longitude: 0 ° ❑ ` ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
&7
O
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other _ i
Dry Poultry
❑ Layers
El -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
❑
Datry Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: IT11
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 E3 No ❑ NA ❑ NE
❑ Yes
❑ No
I'_7 NA
❑ NE
❑ Yes
❑ No
2 1�A
❑ NE
L7 NA
ElNE
❑ Yes
No
El Yes
,❑�..,,
LfNo
❑ NA
❑ NE
❑ Yes
3<o
❑ NA
❑ NE
12128104 Continued

v
r
Facility Number:
Date of Inspection -03- /O
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 l Structure Z Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .2 -3
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 dNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 01 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LJ 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 3 o ❑ 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 2 o ❑ NA Cl NE
❑ Excessive Ponding ❑ 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
\ \ inliM+v� �NN44/S
12. Cropkype(s) �e+rw�a.c�e— (coM5<_l � 0b,'Je..-6A2 5w.aliGra�nt (0-5,. CorAl- „`�'^cs
_f
13. Soil type(s) No R
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes <o ❑ , NA El NE
15. Does the receiving crop and/or land application site need improvement? El[ Yes 'Now ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [G� o ❑ NA El NE
17. Does the facility lack adequate acreage for land application? El[ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Ef ❑ NA ❑ NE
iv-y -,. ... A�::_3 4dt'd P $ _}. d as Yds ,. :y._
Comments (refer:to,questibb #)•E;xplaim any YE.S answers andlor�any recommendations pr. any other comments.
Pic drawings of facility tbetter explain situation°sqq (use atidrtiona
ol pages^aS laecessary): yg 7 y 7{�q¢g
-: R. n.. <...wC��, a«sn8r •.8 �,.. $'`�.. z... .F:' �'� t i" 1� �. � �@w s, {`CR:
y¢ ij
4
AL
Reviewer/Ins ector Name i c It ¢.� �,(s = i ` 3 Phone: 4lt�. 5433.33 o a
P.
Reviewer/Inspector Signature: Re,-� Date: 2.03 Z01 O
12128104 Continued

r
Facility Number; 82 — /g$ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes G o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 3<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENO ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'LT' N//o ElNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes B No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L<No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B o
El NA
[I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
LT<o
❑ NA
❑ NE
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
NNoo
❑ NA
El NE
❑ Yes
,O
o
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 3 o ❑ NA ❑ NE
❑ Yes o El NA [INE
El2 Yes ❑ NA ❑ NE
12128104

-91,M.S /a—07--Zo-a y
-- I�I�IIII PIPIIPIY�IIIY�I -
11�111111�
)ivision of Water Quality
Facility Number 2�1 / $'$ O Division of Soil and Water Conservation
Q Other Agency
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: '13' Arrival Time: /0 ; Or Departure Time: County: $WQQA1 Region:
Farm Name: FQYitit Owner Email:
Owner Name: �uwl•S ��+ rC�o`f�. Phone:
Mailing Address:
Physical Address:
Facility Contact Lty`�%S 8c1 l- -Jt ij Title: r e Phone No:
Onsite Representative: Carl fir YQ i Os Integrator: V i L
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: = c 0 Y = Longitude: 0 ° 0 I = 11
Design Current Design Current
Capacity Population wet Poultry Capacity Population
❑ Layer
❑Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: M
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 lM wo ❑ NA ❑ NE
❑ Yes
❑ No
Bl'qA
❑ NE
❑ Yes
❑ No
B- I'A
❑ NE
3-5AA
❑ NE
❑ Yes
❑ No
❑ Yes
a-Ko'
❑ NA
❑ NE
❑ Yes
04155-11 NA
❑ NE
12128104 Continued

G
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z/C!
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 ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CK ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 El Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes <o ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes 3 ❑ 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
l / Wr,N 41, i1:NM�..t l,S
12. Crop type(s) atYw4 tAd A..
13. Soil type(s) No A , Go A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Loo ❑ NA NE
��, 'tvo ❑
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L%�❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes [Q<o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [3 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes QN ❑ NA ❑ NE
Comments(referito question #) �Explaln uny YES; answers and/or�anyr:;ecornmendatlons or ltny, other comments..
/Use drawing��uf,�facllity�Mto�better, explalnsitaatinnsi�{useraddlttotial�ptiages�as�necessa�t�y):
,
r
Reviewer/Inspector Name - i� ,,, RC—VV_A$ l Phone: /D,'t33s333
Reviewer/Inspector Signature: /Q e'- . Date: 9— 23 " Zooc/
Page 2 of 3 12MY/04 Continued

Facility Number: 82_ Date of Inspection zy-dY
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other �,No�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lf❑ 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
FJ'tvo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[I NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,['�-IYo
o
[INA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�3
L3' oo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
3<0
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,NZo
B 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
ffNo
❑ 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
MrNo
❑ 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
Wo❑
NA
❑ NE
A�d`ditlonalCommentsa d/�oDa fngs 4Baku
El
12128104

5 2 --o y -- zoi o
Facility Number 8Z_1ZK:31
vision of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: lf7 Departure Time: County: 4D S4AJ
Farm Name: � ��G�4t`'!y �'r'ry Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: AX0
Facility Contact: C014 s Title: t;'/" Phone No:
Onsite Representative: Integrator:
Certified Operator: �r7 �� �Gk� Operator Certification Number: i9 834%
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
214VO
1 40.0
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o =' = u Longitude: = o =' = {'
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er�
❑Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Desiin Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 0
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 3No ❑ NA El NE
❑ Yes
❑ No
AA
❑LD<NE
El Yes
❑
3No
ONE
2 A
❑ NE
El Yes
El No
El Yes
[R o
❑ NA
❑ NE
❑ Yes
0'No
❑ NA
❑ NE
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 l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z to
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 ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes l?'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 ErNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes <o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,. ,
9. Does any part of the waste management system other than the waste structures require ElLJ
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/improvement?
Is there evidence of incorrect application? If yes, check the appropriate box below. El�, Yes
Lr�'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) Br, V %Lo, ae--- r/1 x G rQ ; S7ma // 6 ro, ni (0, s •
13.
a
,1
Soil type(s) �p� %Jo,B.
14,
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
L�7, NNoo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
N�o ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
,L+-S,
NNoo ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
,h_G,
L��,'No�❑ NA
❑ NE
19.
Is there a lack of properly operating waste application equipment? ❑ Yes
L�'1Vo ❑ NA
❑ NE
;Comments (refer t6 go4stion�#) Eat"p[ain any YES answers and/ror any recommendations or any other comments t s;.
'Usc¢,drnwin,gs. Cacility to„better^explain situations, (use'i°a dittonal p€igcs as,fneces`sary)
Srihs�s', "..[,.; et s• , �.��. .�; .r >€. ray:` r5 of, 4;.Y>, et F'. Jg.,'` Es'
A
7
Reviewer/inspector Name 72�r'K.; R�t.e �S: " Phone: 1t 0. Y33.33 00
Reviewer/Inspector Signature: R Date: 2 — 0 - 'ZOIO
12128104 Continuer!

r i0 -
liacility Number: Date of Inspection
Renulred Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl[ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
Io
❑ 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 Inspectionss El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L✓J No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E Imo
[I NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
0 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2 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?
El Yes
,.,_�
EKO
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
Oal o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ 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
Zo�po
NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
NA
❑ NE
12128104

Exnns 9-0 "4-0 8 e2
Facility Number
I islon of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit
Inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
,�5.,ompllance
009��outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: a 21 - 0 f3l Arrival Time: i'Ssq,, 1 Departure'rime: County: Sca^Dsaiv Region: IfOW
i
Farm Name: if F+ w (=Qrr+ti S Owner Email:
Owner Name: TeAv'te-5 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Carit S pcxy-6j�k ie _ Integrator:_C�„1_Inctyl-aywx'S
Certified Operator: CLLV4t 5 13'tivrWir, L Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =1 = 11 Longitude: = ° = ` 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
eeder to Finish 3G 75
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
Non-L
Pullets
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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: FT
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
❑ No
a 11�A
❑ NE
❑ Yes
❑ No
❑<
❑ NE
B A
❑ NE
❑ Yes
❑ No
❑ Yes
3-5o
❑ NA
❑ NE
❑ Yes
❑'1r0
❑ NA
❑ NE
12128104 Continued

t
Facility Number: 82— / 8 g I Date of Inspection
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [ <o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
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
Bl o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
BNo
❑ 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
,,����
L7No
❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E No
❑ NA [IN E
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
3<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) j �^w. cs��l I�=y G, �`� _ S w.�. �Lt G MI -J 6-C-) COrr.l , W kCCA,
5.011 "AlJ'
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
3"N' o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
Ej<
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
3 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
10
❑ NA
❑ NE
Reviewer/Inspector Name P.i(. k I?e.Vels - --- -- _ - Phone: 1/a, �33, 3330
Reviewer/Inspector Signature: JQ r Re'4 o Date: $-Z/— 2-00
Page 2 of 3 12128104 Continued

Facility Number: gZ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes DeNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
3<0
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El2 Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2' oo
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElD Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
00 o
❑ 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
3<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
ElE Yes
_,/
o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
Yes
ElL-
�,
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
D<o'
❑ NA
❑ NE
Page 3 of 3 12128104

i�
W Division of Water Quality
Facility Number $Z gg O Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q Departure Time: Z : UQ County: r+
Farm Name: r JAI )5-'arne-S Owner Email:
Owner Name: x u._, r [fo Phone:
Mailing Address:
Region: F2W
Physical Address:
Facility Contact: Cur�'S .Borw'^c V-- Title: g;vu' /# Phone No:
Onsite Representative: CZI-4-5 �✓w� �-� � Integrator: C'e916' G A rAf-5
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I 0 11 Longitude: a ° = 6 =
11
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Li Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
t! 7 4- 1 7 -7 ? 7
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?
Cattle
Dui
gn Current
Capacity Popula'tion..
i
❑
Dairy Cow
❑
Daia Calf
❑
Dairy Heifei
❑
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?
[I Yes 19 No Cl NA ❑ NE
El Yes QV No ❑ NA ❑ NE
❑ Yes Q] No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
12128104 Continued

4
w '
Facility Number: TZ — /g$
Date of Inspection°`per-o7
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?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3
34?
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes [A No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes [PNo El NA [I NE
❑ Yes [4 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 [P 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 T 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 ❑ Application Outside of Area
12. Crop type(s) 4 e VP4ud0. (0,,_L OS) Cc rAr, _ Ae4t�0
tAJA
13. Soiltype(s) Cjo/ AA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [X No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [i No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [N No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes P No
❑ Yes LO No
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers. and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
•
Reviewer/Inspector Name j 4ve,t.5 I Phone:
Reviewer/Inspector Signature: .e'er Date: /O —.0 7
Page 2 of 3 12128104 Continued

Facility Number: Z2 - / SS Date of Inspection 1A0 40-6 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes L9 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 approprratc box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5M 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 4 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
(3 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
W 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
[A 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
5 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
[2 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
EZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
8 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit *Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: %' /ru +"'!S Owner Email:
Owner Name: _. SGt4,tie5 �atr'C/O-f Phone:
Mailing Address:
Physical Address:
Facility Contact: S'a►�cs P 1t+ r G /O -64 Title:
Onsite Representative: Cuyfis 9tfvwic:1<
Certified Operator:
Phone No:
Integrator: C6kAfrr c...
Operator Certification Number:
Back-up Operator: I Back-up Certification Number:
Location of Farm:
Swine
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
t34,7,57
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Region: ell 'O
Latitude: ❑ o = I =dt Longitude: ❑ o = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
E
Dry Poultry
❑ Layers
❑ 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
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
[]Yes
®No
❑NA
❑NE
❑ Yes
2S No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
29 No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: $-Z —/gg Date of Inspection 5-.06-0!v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 a Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 19 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 J9 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 EffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Co 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
O No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
❑ NE
maintenance/improvement?
I. 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 ❑ Evidence of Drifl,-//❑ Application Outside
of Area
/Crop /Window
/W+ind
12. Crop type(S) 8tr y w cider H . S/y/l/�GKi� N cci i✓. wllec, T' Sn., /ejy
A Lc�IN �t /.�1jiyN:d a I
13. Soil type(s) /1%v-(*'/ k Gd M s 60 t-7
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ 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
JE1 No
❑ NA
❑ NE
, 's � ., a a rt y �'? �+`$ x s '� i � � �&�y���x�1111
.,-, to question#) ,Explaimany YES auswcrs.andloranyrecommendstlons or�anitecomments.
.,t f fe y to)better explain situations (useFadditionaEpages asinecessary
». ..59Y�t:� .. .2". ,.y .r..a rt4�:eL:fi.✓FE vawwS.i�iw�.'.�raE�'�a
Reviewer/inspector Name [ {�i'C Phone:
Reviewer/inspector Signature: Aewi, Date: 5-'0 - ZDA j j
12128104 Continued

Facility Number: 9Z —/g 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 ZI No ❑ NA ❑ NE
the appropirate box. ❑ WGp ❑ 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 ❑ t20 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® 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
M 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
® 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
0 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
;N 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
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
A�Iditional Comments and/or Drawings:. s `.-
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine &ISmplaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: (9 P_7i_ Lkj Owner Email:
Owner Name: � L6L±f zzs _ Cxi ��0 _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �� a, rCL2��_ _Title: Phone No:
Onsite Representative: T �^-�_._, - Integrator:
Certified Operator: Sip _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 6 Longitude: = ° = 6 = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: Zh
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 N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
;&No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
&ZLNo
❑ NA
❑ NE
12128104 Continued

inspection
Facility Number: --/ Date of Inspection �(o
Required Records &_Docu_ments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA k 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 ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 14 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
❑ No
❑ NA
ONE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
BNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
RNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
ONE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
RLNE
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
0 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
Z 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
�9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
F.No
❑ NA
❑ NE
'Additional Co�iments andlnr:Draw'in s ''� brq{�sty `yry���JJ''t�tr�,�`'1° * d N5
,h .,b F k ? ,; if �' �I! .�'a [ e ,fr",x.��`)•.AERVd i:J�..wA�� s"'is#iid9,.:e�r'JL.. uIN �, VE
12128104
12128104

Type of Visit Q Compliance Inspectlon 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: „y /G/a�. Arrival Time: y -.3 a Departure Time: C� County: _5u w pn o..+ Region:
r� t
Farm Name: !" Owner Email:
Owner Name: Phone: '71p _S'L N — q %L4
Mailing Address: _ /X:r7 � r i2�. _-- 'Q os 4r-- barn , C a 3i�2
Physical Address: A . aRr z t t^ \11_0 1 R� . a J <A 4> le a
Facility Contact:
Title:
Phone No:
Onsite Representative: Cu,+: kr , Integrator:
Certified Operator: 'T. V~ r_s Fan �e-CA a Operator Certification Number: 1
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
Back-up Certification Number:
Latitude: = e = Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ens
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dai Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
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 [M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
(K] No
❑ NA
❑ NE
12128104 Continued

Facility Number: ,� -- /g�
Date of Inspection 3 of
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 6
Identifier: J.
Spillway?:
Designed Freeboard (in): 1 60
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 property 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
FX] 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
M No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Croptype(s) ��� 1-{nu. SGhS
13. Soil type(s)
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
® 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
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Co m itfsr{ efer to`questlon`#)��YExplain any YES answers4andlor any` r comniendstinns'o ny�u the m' m nts:
¢ a:
Use drswings�of:fscillty to betteraexplain situations ;(use additionahpagestunnece0ary):, .
1 � +r' .-n'M wq-' art a 3' t'h C. T'►v W�U `� a �7 C � ,n y cL c � r[.�(.] tc� 6 4
rwbbla. + ec.ksZ rKn+—aa
irrr w+4Lv* 1
Reviewer/Inspector Name Phone: Sl��
Reviewer/Inspector Signature: Date: 3 ),c %df
12128104 Continued

Facility Number: Date of Inspection 3!4 �
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes m 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 [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 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?
El Yes ®No ❑NA' ❑NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes (j�4. No ❑ NA ❑ NE
El Yes [ZNo ❑NA ❑NE
❑Yes [ANo ❑NA ❑NE
❑ Yes ; No ❑ NA ❑ NE
❑Yes QDNo ❑NA ❑NE
El Yes PNo ❑NA ONE
❑ Yes
�9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
w. c•
Air`ddlfional Coipments nndlnr Drgwings: ;; F i
12128104

Facility Number
Date of Visit: Time: : II
Not Operational Q Below Threshold
[permitted ertit"ied © Condluonally Certified Lj Registered Date Last Operated or Above Threshold: .................
FarmName: .......F�................W t.w4..................................................................................... County:...... Sv?................................. .......................
Owner Name: ...... Taet.....�r.�P.l�!► ............................
....
.............
.....................
pPhoneNo:..... T..�. 1 ..(!�o►�....5i..'..(°yr�
Mailing Address:...... ASS.1.............. oal c6wS.........`-',,40t,.'.... 4j:................... f? pSt......A.C............ �.'. 93 f.2.................... ..........................
FacilityContact: ........................................................................... Title:................................................................ Phone No:...................................................
Onsite Representative: ..... CAC_ �...... ±)<.................................................... Integrator:..... 41 4.t [...... Antr...................................
Certified Operator:,� +fc `............................................................. Operator Certification Number: .... �l. 7..................
Location of Farm:
wine ❑ poultry ❑ Cattle [3 'Horse Latitude • 4 " Longitude ' 49
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E;No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes M No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes I_No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [g.PhU--
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [FQo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................
................................................................................................................................................................................
Freeboard (inches): it�c�►t�
12112103 Continued

Faeltity Number: �(a — IS$
Date of Inspection ' o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and: the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Applieg ion
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
U. Crop type blrw,KdR , Srr►a�� .ae
13. Do the receiving crops differ with those designated in the CA
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Animal Waste Management Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Reguired d t
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes 9441
❑ Yes l_70
ElYes M'Wo
❑ Yes
❑ Yes LN-10
ElM
Yes - o
❑ Yes
❑Yes
Yes
rNo
❑ Yes
❑ Yes
�
❑ Yes
o lqo
❑ Yes Q o
❑ Yes Ly.'N�o
El Yes E,
❑ Yes ,Q-�
❑ Yes LRvo
❑ Yes
❑ Yes
❑ Yes
Cl Yes
ET�o
L'_fNo
l rJ-'too
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
® A-� ) tiHp y>,;. y y,�.®.ray+ry
Comments referturt ueskioti#x lain an YES, unswers;antllar an recamniendatinns or an other ,mments.
Use,I A of facility'ta° better explain situations: (use ailditl0naI pages"'di nec6sit ry) icld CCagz opy ❑Final Notes ���
J SG��+� ��rz
was ��I / a.�•
c�. kL Cvw�* S L �K. �cl' b ra`ria�� r �✓< � Stnna
cC �
J�
his 94 SA-y b-S + r
Reviewer/Inspector Name i.
Reviewer/Inspector Signature:
Date:
05103101 0 Continued

j
Facility Number: — CR Date 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?
Oel WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ 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
❑ No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Eg,!res
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
es ❑ No
32.
Did the facility fail to install and maintain a rain gauge?
5J"s
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
M-Mo
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑-N-b
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑NO`-
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: ��'-)_
Facility No. i
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: J j v -� U , 1995
Time: I � ; Jk
Farm Name/Owner: _ P 4- V) - - P C., '— s
Mailing Address: Z2 , f; t 0-2k. _a 5 �i !'� �.s «�•r� c a d- _,
County:3
Integrator:_ / h gir-, Phone: e6 6
On Site Representative: C �,�� �_(� G w G k Phone:
Physical Address/Location: 6:i Z _
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Z� Number of Animals on Site: 4:z2QZI
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: " Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6or No Actual Freeboard:�Ft. O Inches
Was any seepage observed from the la n(s)? Yes or & Was any erosion observed? Yes orl
Is adequate land available for spray? a or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? &or No
100 Feet from Wells? -0 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or( to
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes or Na
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management reco (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

r , Site Requires Immediate Attention: Pt
} l� Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANWAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - La , 1995
. Time: ?— :
f
Farm Name/Owner: _. f to- JA� FAA"d
Mailing Address:
County:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location:
f
Type of Operation: Swine jeo_'�_ Poultry — Cattle
Design Capacity: Number of Animals on Site: 44 geovv `!2a4 e _
DEM Certification Number: ACE DEM Certification Numbe ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + ,25 year 24 hour storm event
(approximately I Foot + 7 Inches) <ee or No Actual Freeboard: Ft. _Inches
Was any seepage observed from the 1 (s)? Yes or@Was any erosion observed? Yes or 1a
Is adequate land available fors ray? e r Nols the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? JZ�br No
100 Feet from Wells? QD or No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? Yes or%
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 1) If Yes, Please Explain.
Does the facility maintain adequate waste management reco s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 'Vi'"r No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
if the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheen, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm Name:
F7 4, �(I ��''"
Mailing Address: h4. 1_7
L7l 7 r D
County: r.. / Phone No .9ie? re 4 - Z-- 6 .
Owner (s) Name: �a�+�sllu�l�,e �,rr%-
Manager(s) Dame: .S
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.) Sk, 1 / 6 ,4„ dr,.ti -. C4' F g«rl"'�
fv & .a u e Y I ; l L !-d s;2 /a./ 6 - _ .t A, 4 5 ..,., .' leis
Latitude/Longitude if known:
Design capacity of animal
w ste management
system
(Number and type
of confined animal (s) )SAD
•-fr�,sl,,�.
i/Ess
Average animal population
on the farm
(Number and
type of animal (s)
.raised) :
Year Production Began: ASCS Tract
Na.:
Type of Waste Management
System Used:
G&
ce^ elr�r
Acres Available for Land
Application
of W
ste:.
owner(s) Signature (s)
DATE:
v�
DATE:
S rv� s D%b
/ C- a
C
A� fi N
r 7 I'✓1 ! lr 5 /`�3

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