820202_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Q iMS
is, 6U
type of visit. l:�,�ompnance inspection v Loperation meview iJ atrucmre rvaivanon V iecnmcai Assistance
Reason for Visit: dRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z Arrival Time: Departure Time: ; j County: SAW-5 oft) Region: -
Farm Name: tag Owner Email:
tj
Owner Name: J ti O! b s; At Vk O t 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: a w , 5 ��, �� _ Title:
Onsite Representative: {({'
Certified Operator: K IAA �(- � vh p �c S
Back-up Operator:
Phone:
Integrator: &3-s
Certification Number: 17 F7 a
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
C*apacity
Pvp.
Cattle Capacity Pop.
ean to Finish
Layer
Dai Cow
ean to Feeder
ff
Non -La er
DairyCalf
eder to Finish
Z yi1 Z W
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oul
C aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
OtherN
Turke Poults
Other
Other
DischaEges 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 Ej-1 o ❑ NA ❑ NE
❑ Yes ❑ No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes l�J "o
❑ Yes [3- 6-
�A ❑ NE
❑ 1VA ❑ NE
iA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility. Number: - Z o '2_ Date of Inspection: 2 `t
Waste Collection & Treatment
4. fs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E? o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q-id;!C_ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑.N10--
❑ NA
❑ NE
(i_e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C to
❑ 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
[D' IZ
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ oo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2-Ko
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� o
❑ NA
❑ NE
maintenance or improvement?
I 1 _ Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes Q" No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G 13 8� 1 s& 0
13. Soil Type(s): &
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Ye o ❑ NA ❑ NE
15. Does the receiving crop kind/or ]and application site need improvement? es Lam"" II NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [gN`o❑ NA ❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application? ❑ Yes []--'❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E3,;-ro ❑ NA [] NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ep ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑,N6-- ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [a-'� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ea o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilitr Number: Z - 2v Z Date of Inspection: Z'f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IB'1 1O ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes l-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 lD4o_ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes [?lao ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes D-No ❑ NA ❑ NE
❑ Yes E 'No ❑ NA ❑ NE
❑ Yes Ea'1Vo ❑ NA ❑ NE
❑ Yes ❑i oo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes U�-<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes []�Io ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes D<a ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Cox
5j_-V -
�tew Vf I �r r I t(_) 4,-0 �.C� f—, �2_�
c"dt
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: ,(O-11-7-2
't
Date: 946,p
21412015

3
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q<outine 0 Complaint 0 Follow-up 0 Re%rral 0 Emergency 0 Other 0 Denied Access
r7 A
Date of Visit:
Arrival Time:
1.11a
Departure Time: J�_j County: _Y1
Farm name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: 43p ` 15&*11KiW( Title:
Onsite Representative:
t!
Certified Operator:
Back-up Operator:
Location of Farm:
r
Latitude:
Phone:
Region
Integrator: A e] ^ 5.
Certification Number: 17
Certification Number:
Longitude:
x
Design
Current
Designur Cent �, Design Current
Swine
Capacity
Pop. Wet PoultryCaactyPop Cattle ; Capacity Pop.
F,j
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
�w
Dairy Calf
Feeder to Finish 0 }
4 Dairy Heifer
Farrow to Wean
,M a
Destgti�,'Current4* D Cow
Farrow to Feeder
- : D p P,olElt .Ca sett „P60.on-Dairy
Far -row Farrow to Finish Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Crow
Turkeys
Other
Other
TurkeyPoults
Other
s
f�
Y
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 [g4to ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes La'No
t
❑ Yes [!f`No
O—NA ❑ NE
u NA ❑ NE
JaNA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facie Number: - p Date of inspection: 'L
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 [- F- ❑ 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
®�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C�­No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[a"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[TNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [:5�o ❑ NA ❑-NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facie Numlfer: - LQ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EgM ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ -10 ❑ 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 [Zg3qo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [r No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes [R'Ao ❑ NA ONE
❑ Yes gE `No ❑ NA ❑ NE
❑ Yes [2'&o ❑ NA ❑ NE
❑ Yes E; To ❑ NA ❑ NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
EZ'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
[%f No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[2'No
❑ NA
❑ NE
Comments (refer to question ft' Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations ((use additional pages as necessary).
C-6t,(k r04 t �j
Ott q - 3h --6 41
Reviewed] nspector Name: Z1� _ (�M _ Phone
T�
Reviewer/Inspector Signature: Date: O<
Page 3 of 3 21412 15

i ype or v lsit: kff zoutine
nance inspecnon V vperanon �ceview V �rruccure >rvatuaaon V ecnntcat �►ssisrance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: DepartureTime: County:
Farm Name: `J r`''k N' �f �'x'"`� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: Phone:
Onsite Representative: Integrator: w+V - s
Certified Operator: St _wa"o A'
Back-up Operator:
Location of Farm:
Latitude:
Region:r�
Certification Number: "! C 60 9 r
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity . Pop.
Wee oultry Capacity Pop Cattle
Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
I INon-Layer
I
I
ai Calf
Feeder to Finish 7Dairy
Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D . ,:1<'oult . Ca achy Pao '. Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Caw
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [� ❑ NA ❑ NE
[:]Yes [:]No e'PA ❑ NE
❑ Yes ❑ No Lff NA ❑ NE
❑ Yes ❑ No
❑ Yes [r10
❑ Yes 2No
[A A
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Focility Dumber: jDate of Ins ectiom, 2.0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [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 P<o ❑ NA ❑ NE
(i_e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[Zjb?6_
❑ 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
1�3<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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
2r Io
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[;3 o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [20<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): j + ..,AfppII s& 0 M/ - P
13_ Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
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?
IS. Is there a lack of properly operating waste application equipment?
Reed 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.
❑ Yes [;�Xo ❑ NA ❑ NE
❑ Yes [R'I�o ❑ NA ❑ NE
❑ Yes
[3No
[:]NA
❑ NE
❑ Yes
E5No
❑ NA
❑ NE
❑ Yes
[ 1<o
❑ NA
❑ NE
[:]Yes [�No [:]NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo
❑ 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 IdNo
23. I€ selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili ?umber: - p Date of Ins ection �3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Lldl"o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C[ o ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes [aeNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes R2'oNo ❑ 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
[]?<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
5 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
hio
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[:Jl�o
❑ NA
❑ NE
Comments (refer to question #) Explain any YES,answers and/or any additional recommendations or: any other,comments. `
Use drawings -of facili#y to 6etEer explain situattons'(use additional pages as necessary)..
e.
3�
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

449 1�- _:-I-15
Type of Visit: (t7Com ance Inspection 0 Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: t}-p earl{' Arrival Time: - r [(S Departure Time: 10 r I County: S 4-
Farm Name: ` 44 .S. 44 P-ttso3 F-a— ""- Owner Email:
Owner Name: � K"Q,f Phone:
Mailing Address:
Physical Address:
Facility Contact: CA-5 ✓`L.'ccl� Title: Phone:
Onsite Representative: L Integrator:
Certified Operator: S�yWs Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Des n Current Des 4 R -
g ig- Current
Design Current
Swine CapacityWet Poultry Capacity Pop:
Cattle Capacity Pop.
Wean to Finish La er
DairyCow
Dai Calf
Wean to Feeder
Non -La er
Feeder to Finish
-'!" "
-- Design Cuirren_t
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Dr IP,-oult , Ca aci P;..o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -La ers
Boars
Putlets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
a<, ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
C!FA
❑ 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
[ 1`A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3'96
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
❑190
[] NA
❑ NE
of the State other than from a discharge?
Page I of 3 214120II Continued

[Facility Number: -LLb Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [EITlo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6 ❑ 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
[J No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q"11To
❑ 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
To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CfNo
❑ 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): SG
13. Soil Type(s): Q 24ii,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3 j"'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5'NVo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o5
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
[3-No-
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑111;ro
❑ NA
❑ NE
Required Records & Documents
90
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[::]Yes C3 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes C�`No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [TNo
❑ 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 B N-o tJ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-N 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [5 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. 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.
El 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 reviewtinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
c D ✓'
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ Yes L.LKo ❑ NA ❑ NE
❑ Yes [gKo' ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑Yes QNo ❑NA ❑NE
❑ Yes [ N
❑ Yes [ No
❑ Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 10
Date:. +
21412014

YW 5 � K, w I q
Type of Visit: 06C'6mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Otherr' 0 Denied Access
����
Date of Visit: Arrival Timer Departure Timer County:YJ� Regiod: " T/
Farm Name: Owner Email:
Owner Name: C Phone:
Mailing Address:
Physical Address:
Facility Contact: C •V+1 a V_W ( tle: Phone:
Onsite Representative: Integrator:
Certified Operator: tiJ 04'OtbK �� WPN&_,_0 Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity
Pop.
Cattle
CapaH Pop.
Wean to Finish I
JLayer
Dairy Cow
Wean to FeederI
INon-Layer
I
Dairy Calf
Feeder to Finish
- -- -
Dairy Heifer
Farrow to Wean
Design
C>urrent
Dry Cow
Farrow to Feeder
D , P,outt , " °. Ca : ci
I'o
Non -Dairy
La ers
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [g.Nv-_'d NA ❑ NE
❑ Yes [:]No [2,N1K_ ❑ NE
❑ Yes [—]No h A ❑ NE
❑ Yes
[:]No
E34AA
0 NE
❑ Yes
E3 o
❑ NA
❑ NE
❑ Yes
Ea'110
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

too
Facili Number: Date of Inspection: `
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3.W� NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No —❑ 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? D j.es 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 iR'v" ❑ 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<0 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes , o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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): I.S- t u
13. Soil Type(s): loo &
14. Do the receiving crops differ from those designat/d in the CAWMP?
❑ Yes
Q o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6<o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E KNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E rNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
<No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
r3'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [—]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall InspectioF
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
NA
❑ NE
Page 2 of 3 21412011 Continued

i
Facility Number: - Date of Ins ection:
Af
Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
. 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
E I�❑ NA ❑ NE
EFrvu LI NA ❑ NE
[:]Yes
�l
❑ NA
❑ NE
❑ Yes
[3'15�o_
❑ NA
❑ NE
❑ Yes
[ji-Wo"
❑ NA
❑ NE
[:]Yes [5—No ❑ NA ❑ NE
❑ Yes [T No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
[ —4& ❑ NA ❑ NE
No QNA ❑ NE
NA ❑ NE
Comments (refer to question #): Explain any -YES answers and/or any additional recommendations..or4any other comments:*«
Use drawings of facility to better explain situations (use additional pages as necessary). =%
Reviewer/Inspector Name
11 Lk.
Reviewer/Inspector Signature: Date:
Page 3 of 3
21412011

r
type oI visit: LY.c.ompuance inspection lj operation meview V atructure nvaivation V lecnnicai Assistance
Reason for Visit: QW-outine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: S jC� Arrival Time: Departure Time: Q q� County: e�q
Farm Name: �MsC-AtIS�� �p�, �AR►'''1 Owner Email:
Owner Name: AV SaXN\i \bRS Phone:
Mailing Address:
Physical Address:
Facility Contact: 0- jt,�� APLkATS.Cr r Title:
Phone:
Region: _F!�2_
Onsite Representative: Integrator: V\V R 4n�'�t.i Q RU_
_ I
Certified Operator: V)onym) R , Ea j Nmc^5 Certification Number: L9 $)QC(
Back-up Operator: Certification Number:
Location of Farm:
1. Latitude:
Longitude:
IMgn C Desiurrent "Design Curren# Design Curren#
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish n
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P,oult p _ . Ca aeity P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qthcr Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ET o ❑ NA ❑ NE
[] Yes ❑ No E0 A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[—]Yes
❑ No
[EYNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑Yes
[Vo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
FfrINo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: ja - jDate of Inspection:
Waste Collection & Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [4�'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No QINA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4-1
Spillway?: _
Designed Freeboard (in): �1 --
Observed Freeboard (in):rJ^
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes �No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Eto
❑ 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�1 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? []Yes [:YfTo
❑ 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 Wo
❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [D4o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo
❑ 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 ❑ Eviddencce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1_Z F_RV\U(i I / , �_AIA-41tC\ I fs r.- r) �U_k)NMfR fl1�h�R��.
�A6AO_ Nn
13. Soil Type(s): ),C--�-
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 EyNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes jZrNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes &No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes dNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [►No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:)Yes allo ❑ 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 S2�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ 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
&NA ❑ NE
Ls
Page 2 of 3 21412011 Continued

1
Facili Number: - `o. Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [1], "No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [�TE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:)Yes [UAo ❑ 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
0"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
E2*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
[B"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
[ErNo
❑ NA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[t'io
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&�No
❑ NA
❑ NE
Reviewer/inspector Signature:
Page 3 of 3
Date:
21412011

I
Big, s -7//51l//
Type of Visit: UCompliance Inspection O Operation Review (] Structure Evaluation O Technical Assistance I
Reason for Visit: 911routine 0 Complaint 0 Follow-up O Referral O Emergencv O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: dw Per Owner Email:
Owner Name: JA Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: LIr'l-t+n� Ll�l _ Title: 1 Phone:
Onsite Representative: � � Integrator: / '/ —16
Certified Operator: �� 51 h,,y��Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
t II ►Design Current
Swine Cap ity Pop.
+
Dest Current
Net PoultCapacty1Pop.
a
Des' Current
Cattle C►apacity Pop.
Wean to Finish
ll
Layer
Dai Caw
Wean to Feeder
Non -Layer
Dai Calf
eifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
zDesign _Current
D , P.oul gCa aci Iko
I Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish La ers
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turkey Poutts
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[O<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
EKNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
2rNA
❑ 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
EErNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P3"Nio
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
64o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

t
r
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �fo ❑ 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:L
Spillway?:
Designed Freeboard (in): Iq
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [g-Ko ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [—]Yes �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ti Io ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) J
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑,N`b ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [D<o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M4 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
Lk 'r
14. Do the receiving crops differlfrom thosl designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
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?
❑ Yes E No
[:]Yes 04)
[:]Yes 0240
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ Yes fl2<o ❑ NA ONE
[—]Yes &3'No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�--��
l��l l'"'
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2<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
❑'K'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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
NA
❑ NE
Page 2 of 3 2.1412011 Continued

ti
Faeffity Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g;?Ko ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �fo ❑ 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 [3-IL ❑ NA ❑ NEE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA Emile
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 10 ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes L No ❑ NA ❑ NE
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 E3 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes Io ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other commento
lUse'drawings of facility to better explain situations (use additional pages as necessary).'
,_
Reviewer/Inspector Name:
iru s o► 1--es
Phone: l/10
Reviewer/inspector S
Page 3 of 3
Date:

i 3T'M5 z-09-2o)o
Type of Visit
Cornpliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
el Routine 0 Complaint
0 Follow tap 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: S"'�s�'� Region: -*�-420
Farm Name: �ltr�nac�5"'"` _ Owner Email:
Owner Name: �a �`""'rDIUS Phone:
Mailing Address:
Physical Address:
Facility Contact: Ct: r+�5 �Q ✓kl +GIB Title: % SPe-C_' Phone No:
Onsite Representative: integrator: C. oIle,-1
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =' =' E:] Longitude: = o ='
= u
Design Current
Swine Capacity Population
❑ an to Finish
❑ an to Feeder
Design Current
Wet Poultry Capacity Population
I0 Layer
ID Non -Layer I
Design C►urrent
Cattle Capacity Population
❑ Dairy Cow
❑ DaiEy Calf
Feeder to Finish Z 201 i
❑ Dairy Heifer
❑ Farrow to Wean
Dry Pottltry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
10 Other
Number of Structures:
Discharges & Stream Impacts //
1. Is any discharge observed from any part of the operation? El Yes B o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
EJ'�lA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑JY1A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�lo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
to
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

r
Facility Number: S2 —2OZ
Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes L'7 No
❑ Yes ErNo
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZT
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El"No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ON ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L' I 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 I( No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlieation
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. El 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) aEy.,wi( dA, f`�r � Sha � GrairV i0.5, Su,.,,.re F W;�dc- A-1,VKe%5
13.
Soil type(s) AIM LA a,.
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
El NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? El Yes
��No
NNo El NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
,L�J,
L� No ❑ NA
❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Yes
NN El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
,�
[R o ❑ NA
❑ NE
Comments (refer to gnestronk#) .Explain"any S'answers and/or any recommendations or any,other comments
'Use -drawings: of facility to better explain situations. (use additional pages assnec ses ary).��`---
-
Reviewer/Ins ector Name �c t fs M Phone: `llD, r{33. 330 a
p R vc R
Reviewer/inspector Signature: Date: Z — 473 — 20 /D
I2/28/04 Continued

Facility Number: 82 202 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
L"I No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ff N' o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNoo
❑ 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 2 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E3<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerlinspector 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
ONo
❑ NA
❑ NE
12128104

tF_L*S e,,,J-crzd I0-6z — z4O q
Division of Water Quality
Facility Number E
() 2 O Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C�ommpliance
(D Koutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 9-2.3 -4 % Arrival Timerr: __/.'pS �,,� Departure Time: County: _ S'!y_:Ert' J Region: �'�O
Farm Name: �l ruwto"s 1'tm `{ r'�Y+"'�_ _ _ Owner Email:
Owner Name: Qy S i k^w+cn -S Phone:
Mailing Address:
Physical Address:
Facility Contact: Cuts $arw! e. K Title: �"L" S'` ` Phone No:
Onsite Representative: Integrator: Co AaVt c F_o,.W -�S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 ❑ , ❑ « Longitude: = o = . ❑
Swine
Wean to Finish
Wean to Feeder
ee der to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
i ❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Puliets
❑ 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 Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures: ELJ
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 ONo ❑ NA ❑ NE
❑ Yes
❑ No
ffN
[IA NE
ElElG Yes
No
<
❑ NE
B<A
❑ NE
❑ Yes
❑ No
❑ Yes
N�o
ElNA
El NE
El Yes
B-<o
❑ NA
❑ NE
12128104 Continued

-Z3 —0 9
Facility Number: 82 — 202Date of Inspection
Waste Collection & Treatment �,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ETNo ❑ NA [3 NE
a. If yes, is waste level into the structural freeboard? El Yes��No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2<01 ❑ 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?
❑ YesUPNa
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
MNC
❑ 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
ElYes
�
[j3 o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
�
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2KO
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
,.,
Lf'No "
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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) gel -PH", �(.�►�;� � Sha4/% ^
13. Soil type(s) A , Aw
! �►
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L'7 No
❑ 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 acre determination?❑
Yes
,2
& o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NN
El NA El NE
I & Is there a lack of properly operating waste application equipment?
El Yes
, _,
L�'No
❑ NA ❑ NE
G-,- vzo C/.
Reviewer/Inspector Name f-V Phone: ���r �3_ ,. 333{
Reviewer/Inspector Signature: �4 Date: y' 23 — 200
Page 2 of 3 12128104 Continued

Facility Number: SZ — 20 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 io ❑ NA ❑ NE
the appropriate box. ❑ W1Jp ❑ Checklists ❑ Desig
n El Mans ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ 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
,B'NNo
L'No ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o El NA
[INE
26. Did the facility fail to have an actively certified operator in charge?
ElE Yes
No ElNA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
BNo❑ 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
E3N* 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
,__,,��
D 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
El Yes
,_ ,
L�'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?
El Yes
2<0
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
"❑ NE
12128104

TFL4S q-oy-og F—R— --
tvision of Water Quality
=1=J=1Fj,aei111ityutuber ' Z�Z 2- 0 Division of S-oil and Water Conservation
---�� 0 Outer Agency
E
f Visit l�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit aR utine 0 Complaint 0 Foilow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: 19Z/ O 19 1 Arrival Time: !.%D ,.r Departure Time: ���� County: ��'�^ Region: OeAeO
Farm Name: Sr'+� S �o �4' t-01 ► Owner Email:
Owner Name: /Q4y 5�.+�►w�eiv s Phone:
Mailing Address:
Physical Address:
Facility Contact: Cur4�S Title:cZ • Yas�_ • Phone No:
Ceur�`s 8� rt�'4�
Onsite Representative: „ i? a S+ �+,.....o^r s _ integrator: a+'i
Certified Operator:
Operator Certification Number -
Back -up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: = e = 6 =
66
Design Curren#
re�Capacity Population
Finish
D s g F Current
Wet Pou!lryCapaciiiy Po elation
-p
❑ La er
Design Current
Cattle Ca aci Po uiation
p ty P
❑Dai Cow
Feeder
❑Non -La er
Dairy Calf
❑ Feeder to Finish Zg1/O Q 6 41'
❑ DairyHeifer
-
❑ Farrow to Wean'"`
Dry Poultry
- `
❑ Dry Cow
❑ Farrow to Feeder
"`
'
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑ N ers
❑ Beef Feeder
P arBos
Pullets
❑ Nets
JE1 Beef Brood Cowj
❑ Turkeys
Other
❑ Other
❑ Turkey Points
❑ Other
Number of SEructums: EE
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
�/
E o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[31�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑^A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
1_TNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
][�" oo
0 NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LSNo ❑ NA
❑ NE
other than from a discharge?
Page I of 3
12,128104
Continued

(Facility Number: '?Z 202- Date of inspection 5-22 -O 8
Waste Collection & Treatment
/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ETNNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
L7 No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in): 3I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eJ 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
,. ,�
E3<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 2 o []NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 3-T-No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
IJ 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) Ci'bK (� r�'i L-L _ G r ; ri c/o S •
13.
Soil type(s) AIV _ A_
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
L1 No
❑ 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 acre determination?[] Yes
E3�
❑ NA ElNE
17.
Does the facility lack adequate acreage for land application? ElO Yes
o
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
0'lqo-
❑ NA ❑ NE
Comm N(refer, to qu st�oi'i, x ` E p In any YES answers an ur p y ra mnm a oas or any other cowmen
rY).�
Use drawin�s�of fac�l► to better�ea lam srtuatroiis. use,addst,on
sa
AL
Reviewer/inspector Name 1 JC e; vL S Phone: [phone]
Reviewer/Inspector Signature: Date: P r 2! — ZOD 8
Page 2 of 3 12178104 Continued

Facility Number: 92- —1(1 Date of Inspection a Z!'Q S
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 L914 ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other ,/
21. Does record keeping need improvement? if yes, check the appropriate box below. El Yes E o ❑ 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
9'6o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,L.�fN//o
[R o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Boo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D oo
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
3'9a
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 Flo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
��
El 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
,_,/
B 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?
[-IYes
0 NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
,L�_TNoo
9 '1Qo ❑ NA
❑ NE
60i0Onal;GUmmenfs ani or Drawings. ,� � ." ,'' t? do
i
7
Page 3 of 3 12128104

Q Division of Water Quality
Facility Number gZ ZO Z O Division of Soil and Water Conservation ,
0 Other Agency
Type of Visit 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /O-pl-D i Arrival Time: /: 3S Departure Time: z OD County: Region:
Farm Name: Owner Email:
Owner Name: /Q Si Ar�eniS Phone:
Mailing Address:
Physical Address:
Facility Contact: Ci1y-k5 Title: V /�ppPhone No:
Onsite Representative: 4 rukS sa&jZA __ - _ Integrator: 0046. _i a F;Yr" S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [—] e 0' = « Longitude: = o E� i = id
Swine
Design Current Design Current
Capacity ,Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
I 'ZqqO
127yi
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Xiurri
Cattle CapacityPopula
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
[3No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[� No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[�j No
❑ NA
❑ NE
12128104 Continued

+ Facility Number: gZ - ZOZ
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes No
❑ Yes No
Structure 5
❑ NA ❑ NE
❑NA El NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7'3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [F No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [yNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes q No ❑ NA [:)NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) �t',trUa a., CG L� S„„� l f Cg+a; ►.s C0.S . �) 5i4 i,JA
13. Soil type(s) _ N� _ Ak-
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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
W C.AJ ivy t l�f t�T1 C t4 �4 W` ct n i'4 YC_ r� �•
7
Reviewer/Inspector Name d's Phone: 4e33. 33po
Reviewer/Inspector Signature: Q,,,"Ll-I Date: /O -m/ - ZOD 7
12128104 Continued

Facility Number: $Z — 2pZ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [;5No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Qi No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 14 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the perm t?
❑ Yes
EM No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
(� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[,VNo
❑ NA
❑ NE
Other Issues
28..Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[y No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
allo
❑ 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
V 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
14 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
[0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality �'%f� ✓
Facility NumberEkE]4�1
0 Division of Soil and Water Conservation gyp— --i5'7
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1«__-L^d _r Arrival Time:07.9z7)]Departure Time: 4"V 0County: Region:
Farm Name: .✓ -C� m Owner Email:
Owner Name: _ i I I I v _d t Phone:
Mailing Address:
Physical Address:
Facility Contact: c i� 1&G - i 7'1— Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phhonnee No:
Integrator:�J/ter s�-
Operator Certification Number: 17,5 2
Back-up Certification Number:
Latitude: = o = [ = Longitude: = o =' =1 it
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle CapacityPopulation
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish i) a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
F
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 R!,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection IDS
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 ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 12
Observed Freeboard (in): d 1,
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes 13No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CKNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 C9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U.No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ANo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
U
14. Do the receiving craps differ from those designated in the CAWMP?
El Yes
KNo
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P4 No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(O No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JKNo
❑ 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):
O i 5 l / Gr i n Yj i
ZZVit' ( OU I +
Reviewer/inspector Name Phone:�_t�33�,33a�
Reviewer inspector Signature: Date:
_ la= /'�0�%
12128104 Continued

i Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? if yes, check ❑ Yes & No ❑ 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. Oyes ❑ No ❑ NA ❑ NE
&Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
fgNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
� No
El NA
El 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
El Yes
lC 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D�No
❑ NA
❑ NE
Additional Comments and/or Drawings: L
a s N4� u M Pe 'W V,-h 5 3
e- �(� P" � 7{g 7�4s
wer k .
12128104

i-
t
Type of Visit ® 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: `.a~Oe Oho Arrival'I'ime: Departure Time: L County: - M&,-J Region: i�0
Farm Name: S; M aACA/S /Zep ,4r^ t _ Owner Email:
Owner Name: A.g 5iM"be.✓S Phone:
Mailing Address: _!i 6� z// Scts_5 LaILc, Ad C (wl*anI /VC Z$j2$
Physical Address:
Facility Contact- Plot!] S;"*" 40Ili S Title:
Onsite Representative: Cat- s Ric.-+; 4:� k
Certified Operator:
Back-up Operator:
Location of Farm:
I. Swine
Phone No:
Integrator: O Ala 1-i -e—
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = Longitude: ❑ n = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
121 *D
/'fSC1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other'
10 Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
�l
Number of Structures: i
J
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 [A No ❑ NA ❑ NE
❑ Yes
®No
❑ NA
❑ NE
El Yes
®No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
® No
❑Yes
®No
El NA
❑NE
❑Yes
®No
El NA
El NE
12128104 Continued

Facility Number: $2 - 2- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes N No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): - �z
Observed Freeboard (in): 3 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
W No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
in No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ^$tr►+t�ta�c� - G�-� c Slv�4/� Grgr'nl. SuN,wrc✓ l��Ni�rf�.��uya%S
13. Soil type(s) 1;1 -e-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
[9No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[21No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑No
❑ NA ❑ NE
�� S
Reviewer/Inspector Name t $' S> + " � ty Phone: (910 y
Reviewer/Inspector Signature: `~ �vc.�..1-sue Date: �d0
12128104 Continued

t
i Facility Number: S Z --ZQ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EXNo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? if yes. check El Yes ®No ❑ NA ❑ NE
the approprrate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(6 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
m No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
On No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
[A 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
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Addifional Comtnents:and/orsDrawtngs: n . _AIMMI
12128104

c7 IS ;2 U oZ
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Id /071 Arrival Time: Departure Time: County: 5aw+,Ci -1 Region:
Farm Name: t, ►" }^^ oN u n a _Fa ►' v— Owner Email:
%Owner Name: e ►.s_ ► 'i" ►-.N n a� s Phone: �� 0�
Mailing Address: _
Phvsical Address: _ _ .5a M e- ^ a -3 e,- _; e+v c __
Facility Contact: Title:
Onsite Representative:
Certified Operator: 1 unq c
Back-up Operator:
Location of Farm:
Phone No:
Integrator: C - k4=- %% 4a-
Operator Certification Number: 7 74�,
Back-up Certification Number:
�o �+ =6 g ❑o ❑' 0 4
Latitude: Longitude:
Design
Current
Designs . Current
�" Design Current
Swine
Capacity
Population
Wet Poultry ; C p city opWahon
Cattle F Capacity Population
x
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
® Feeder to Finish
.29410
�iSv
r st ' ;,
�`{"
❑ Dairy Heifej
❑ Farrow to Wean
D oul{`�{�rs."� k
�i.'v ]char- �J� Y��.'Y�'T,F� R -^,:'
❑ Dry Cow
❑
❑
Farrow to Feeder
❑ La ers
-Layers
❑ Pullets
❑ Turkeys
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
`.
❑ Farrow to Finish
❑ Gilts
❑ Boars
-_.
Other � •:.,
❑ Turkey Poults
❑Other
� � :;.:,,,u
Number of 5trtidures:
❑ 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)
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 [9 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [r0 No ❑ NA ElNE
❑ Yes LA No ❑ NA ❑ NE
12128104 Continued

r
Facility Number: F2 —.?o Date of Inspection l
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 "
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 13 �r .,, . � cr r A r caQ k. b
S c, l e .S
13. Soiltype(s) ���risd',��c� Not V
_
—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W 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
Phone:
Reviewer/inspector Name I j, ,C�a� z w-s. �x
Reviewer/Inspector Signature: Date: 3 fG /OS
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [A Yes El No ❑ NA El NE
.2.( i a.a
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Anafysis ❑ 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
❑ 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
[Z 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
Q 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
[3 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Cammeots:and/or'Drawings..; .
t�
a G %"-J' e- 714" 'f' d ►.L "'a
G- C "' P 1 'c JL
Y�,1raJ-.L brow+ Weft+'_ '_-IdrI; Jl
12128104

of Visit QrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility plumber Date of Visit: EIZ�84 Time: �0
Q Not Operational Q Below Threshold
[] Permitted 0 Certified [] Conditionally Ceerrfified [3 Registered Date Last Operated or Above Threshold: ----- .-.-- ..............
Farm Name: ...... r►!rr+ +tiS .......... County: ✓ _9*4----- -- _ ...� . �..
5,
Owner Name:. Phone No: _. ...... .-T._Q..................................
_.. _ "'""'a"' S _ �._ ... _ ..m.
Mailing Address:jie..
4
FacHity Contact- 5 r 4•.•.�..w..S Title:.. ................... W � .... Phone No: _�_
Onsite Representative: ^ ' 'S .„ +G X ^ Integrator. e--- i
• t 7D
Certified Operator:._..........�};^ wrs.�.�r� _,,.,,._...._._ Operator Certification Number:
Location of Farm:
'' 1W
['Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �" Longitude �• �' �"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes &<o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes BNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [2(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes [ R' io
Structure 6
Identifier:
Freeboard (inches): 0
12112103
Continued

Facility Number: Date of inspection
,>,. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes B No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [ffNo
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 210
8. Does any part of the waste management system other than waste structures require maintenanceJimprovement? ❑ Yes ErNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [g'*No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/unprovement? ❑ Yes IRNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes B No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &Aolltt rjrhal ivt
13. Do the receiving crops differ with those clelsignated mi the Certified Animal Waste Management Plan (CAWNP)? ❑ Yes [ o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes &No
b) Does the facility need a wettable acre determination? ❑ Yes &No
c) This facility is pended for a wettable acre determination? ❑ Yes [91Io
15. Does the receiving crop need improvement? ❑ Yes Ga-go
16. Is there a lack of adequate waste application equipment? ❑ Yes ["o
Odor ]-sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [3-fjo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 2140
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [IYes Q"&o
roads, building structure, and/or public property)
20. At the time of fire inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Q'flo
Air Quality representative immediately.
rr't _ _7
�60 a s e
5filbtl f4r Ig)-, L, ti� 'a 'tit.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Final Notes
Date:
12112103
Continued

Facibity Number: 1VK — at Date of Inspection
.11eguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
B<o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
W40
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
©oNo
[Waste Application [;'Freeboard EWaste Analysis [ oil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ROKo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[j?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 reviewfinspection with on -site representative?
❑ Yes
[lie
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
2No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
&Ms
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENO
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
BNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
ZNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
&?f4o
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
[�f10
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Er No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

State of North Carolina
Department of Environment, PIPFA
Health and Natural Resources 4 • a
Fayetteville Regional Office All
James B. Hunt, Jr., Governor � C
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
July 24, 1995
Mr. Donald Ray Simmons
4641 Bass Lake Road
Clinton, NC 28328
SUBJECT: Compliance Inspection
Simmons Hog Farm (NCSR-1309)
Sampson County
Dear Mr. Simmons:
FR0
ka----Y '4
On July 11, 1995, an inspection of your animal operation was
performed by the Fayetteville Regional Office (FRO). Please find
enclosed a copy of our Compliance Inspection Report for your
information. It is the opinion of this office that this facility
is in compliance with 15A NCAC 2H, Part .0217, and that Animal
Waste Management is being properly performed.
Should you have any question regarding this matter, feel free
to contact me at [phone].
Sincerely,
Ricky Revels
Environmental Technician IV
RR/sc
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayettevipe. North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

• w
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT, HEALTH & NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Farm Name/Owner Inspection Date Farm No.
Simmons Hog July 11, 1995 NA
Donald Ray Simmons
Mailing Address
4541 Bass Lake Road, Clinton, NC 28328
910 592 5854 Sampson County
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation type:
Horses, cattle, swine, poultry, or sheep
SECTION II
1. Does the number and type of animal meet
the (_0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)) 4 houses ® 750 hogs (Finishing operation)
2. Does this facility meet criteria for Animal
Operation REGISTRATION? Stocked fall of 1994
3. Are animals confined fed or maintained in this
facility for a 12-month period?
4. Does this facility have a CERTIFIED ANIMAL WASTE
MANAGEMENT PLAN? Has one now
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
Y N Comments
_x_
_x_

Administration and Program Management Y N Comments
6. Does this facility meet the SCS mimimum
setback criteria for neighboring houses,
wells, etc. x
SECTION III
Field Site Management Y N Comments
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of USGS Map
Map Blue Line Stream? x_
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream? ]t
3. Does the facility have adequate acreage on
which to apply the waste? 100 acres of which _x_
is owned.
4. Does the land application site have cover a
crop in accordance with the CERTIFICATION PLAN? _x_
(Coastal and Millet)
5. Is animal waste discharged into waters of the
state by man-made ditch, flushing system, or
other similar man-made devices? x
6. Does the animal waste management at this
farm adhere to Best Management Practices (BMP)
of the approved CERTIFICATION? _x
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approx. 2.5 ft.) _x_
8. Is the general condition of this animal facility,
including management and operation, satisfactory? _x_ _x_
SECTION IV
Comments
Section II No. 2 This is a new operation that was stocked during
the fall of 1994. This operation was inspected
as a result of a complain. No problems were
found as a result of this inspection.
Section II No. 5 Facility has not applied any wastewater onto cover
crop. Mr. Simmons has ordered a reelgun spray
irrigation system, which should be delivered within
next several weeks.
Coordinates N 34" 55' 22"
W 780 24' ol"

. Site Requires Immediate Attention: _Ale)
Facility No. _zz- 9-OZ
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: 3
Farm Name/Owner: ,
Mailing Address:
County: n6
Integrator:
On Site Representative:,
Physical Address/L.ocati
J
Phone:
Type of Operation: Swine ✓ PouItry Cattle
Design Capacity: Number of Animals on Site: 7-1760
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: \
Circle Yes or No
Does the Animal Waste Lagoon have sufficien
(approximately 1 Foot + 7 inches) Yes or(l
Was any seepage observed from the lres
n(s)?
Is adequate land available for spray?or No
Crop(s) being utilized:
t
freeboard of 1 Foot + 25 year 24 hour sto_r_m event____
Actual Freeboard: a� Ft. _Inches
Yes or No Was any erosion observed? Yes or
Is the cover crop adequate? �Se or No
Does the facility meet SCS minimum setback criteria? 200 Feet from DwelliD(Yes)or ' No
100 Feet from Wells?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 ine: Yes or 00
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or l�o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? jgr No
Additional Comments:
14
PIR
- 2�-� gt�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:_
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: 2-
Farm Name/Owner:_ �i ,in��� g l=aiO4 CG.l#ece �
Mailing Address:
County:
Integrator: en«�_ - Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 0Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) Yes or No Actual Freeboard:_-S,Ft. 4 Inches
Was any seepage observed from the iaptoon(s)? Yes or ft Was any erosion observed? Yes o&o
Is adequate land available 1
Crop(s) being utilized:
Does the facility meet SCS
it No Is the cover crop adequate? Ye or No
minimum setback criteria? 200 Feet from Dwellin ')�(Yebor No
100 Feet from Wells. r 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 me: Yes or
Is animal waste discharged into water of a state by man-made ditch, flushing system, or other
similar man-made devices? Yes orU 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)? Wr No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

s . r
VL
ANXK%L IBA= 9 PLAN CX3tTI7ICATX0K ]rc7t kilt o7t ZSPA = rZ:nuns
Pleese retoWM-tie e00*Ietred !ems to the DirieiOU Of ZKvisoasaatal Yaua902aat at
the `address an tie wwrimsm side of this f *z=.
Name of farm (Please print)_ -
Address: l't 6- 131
Phone No.: 94�7 7Y!� - County: S�• ;
Fares location: Latitude and Longitude: 3f_5�1i"/_ `��t �" (required) . Also,
Please atcach a copy of a county road map with location identified.
Type of operation (swine, layer, dairy, sec.): 4-d , k e
Design capacity (number of animals).
Average size of operation' (12 morth population avg.): 79y0
Average acreage needed for land application of waste (acres): r-
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�eeehrieal S�ecialisC GrCificatiass
As a technical specialist designated by the North Carolina Soil and Water
Consecration Commission pursuant to 15A NCAC 6F .0005,' 1 certify that the aew or
expanded animal waste management system as installed for the fa^s named Glove
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
Environmental Management and the USDA -Soil Conservation Se_ rice and/or the North
Carolina Soil and Water Conservation Commission pursuant to 1SA NCAC 2H';0217 and
15A NCAC 6F .0001-.0005. 'rise following elements and their corresponding minim—
caitaria-haua_.Seen verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (bs:ffe=s); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity aid amount of land for waste utilization (or use of third party) ; access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stor=water runoff events less severe than the 25-year, 24-hour
storm.
Name of Technical Specialist (Please Print): d
Affiliation•
Ada.-ess (Agar—cy) : A �. wwo Phone No.
/V C Q�
Sisaat :re L Date :
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Cwrner/X&=ager Agreement
I (we) understand the operation an maintenance procedures established in the
approved animal waste t:anasesnent plan for the farm named above and will implement
these procedures. I (we) know that ary additional expansion to the existing
design capacity of the waste treatment anal storage system cr construction of new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. I (we) also
uzndersz�a.-:d that t ere must be no discharge of animal waste from phis system to
surface waters of the state either through a man-made =onveya.^.ce or through
rZ:noff from a stcrm event less severe t :an the 25-year, 24-hour storm. The
approved Platt will be filed at the fa= and at the office of the local Sowl and
Water Conservation Dist=ict.
Nam+ of Laced owaax (Please Print)
Al"SDate:
Agate of waaag.r, if different from owner (Please print):
Signature: Date:
Note: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer.
DZt USE ONLY.AC` EW*
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SIMMONS HOG FARM