820219_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

- Facility Number: 9,2 - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Zf 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: / :22� —49
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6, , fig
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [v]'<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 2o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [L�'i�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 r'No ❑ NA ❑ NE
maintenance or improvement?
Waste -Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [N o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Uj'1Qo ❑ 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): 67o,-n Iit�h��A5 i/� �,4 /� '� ,& 49,-, --S r- J l A,/ /. '�71
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
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
13"�o
❑ NA
❑ NE
18. is there a tack 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 dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design ❑ Maps ❑ Lease Agreements
❑Other:
_
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes �/Nj
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

. Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ea"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [J"No ❑ NA ❑ NE
❑ Yes []3"No ❑ NA ❑ NE
❑ Yes E]�No ❑ NA ❑ NE
[::]Yes
[No ❑ NA ❑ NE
�No ❑ NA ❑ NE
Ff�o ❑ NA ❑ NE
❑ Yes
[:]Yes
Comments (re& to questions#): Explain. any. YES answers. and/or any- additional recommendations or any,other�eomnrents. s
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:a-�-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r/n-3o�-�[
Date:
21412015

!Type of Visit: UCo=utine
cc Inspection O Operation Review O Structure Evaluation O Technical Assistance
(Reason for Visit: 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: ,' r Departure Time: /a; a o County: Region:
Farm Name: �r i .� �� /%%Y�t� Owner Email:
Owner Name: d Phone:
Mailing Address:
Physical Address:
r
Facility Contact: Title: ,�)��jPhone:
Onsite Representative: .jIntegrator:
Certification Number:
Certified Operator: I 5-t—f—
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish La er
Design Gnrrent
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
]Non -Layer
Feeder to Finish
Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P.oul Ca aci I;o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Non -Layers
13oars
Pullets
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes CNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CZVNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection: `f
ED .-
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C3-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: _1`y L
Spillway?:
Designed Freeboard (in): f f
Observed Freeboard (in): y -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[gNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3-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
[KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[allo
❑ 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 [3,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window D Evidence of Wind Drift ❑%Application Outside of Approved Area
12. Crop Type(s): 4Zrn. / 1�''� j .�i s �✓ i'/�L �e' / dlil/S i~isI / / 7 */
13. Soil Type(s): L1
1.4,41
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [E]-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O_No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
_[Rj No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[R[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &[ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®, No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection: �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [2,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Callo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes allo ❑ 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 allo ❑ 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
jHNo
❑ 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
[2No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
]Q No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
-® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
Comments {refer to gaestioa #) Eaplaan aay`YES.answers and/or any additional recominenda ions or any atiier comiiieiiWW".
s}rn sluat2ons' use additional- a es as necessa i ( P g ry) g _
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: eJCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: CKoutine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
nr i
Date of Visit: Arrival Time: ,'pc7 Departure Time: = County: Region: '1
Farm Name: fl L v IN Q Kr71 j
Owner Name: a
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title:-/ ✓"'ice Phone:
Onsite Representative: �[, Integrator:
Certified Operator: _Ji%�
Back-up Operator:
Location of Farm: Latitude:
Certification Number: 1
Certification Number:
Longitude:
Current
Design Current
Design Current
Swine CapacrtyPop.
Wet Poultry Capacity Pop.
Cattle Capacity Pap.
w: a_
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design` Current
Dr, P,aultr Ca aci 1?o ".
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
JrTurkey
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
t ''ai i21 F A
}
Turkeys
Oilier `
Poults
Other
Other
Discharees and Stream ImuaCts
1. Is any discharge observed from any part of the operation?
[] Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
t§-No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214120I5 Continued

Facili Number: - Date of inspection: —4 b
ti ,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: !'I` _
Spillway?: _
Designed Freeboard (in): Or—�
Observed Freeboard (in): _ 3P__ 3 ,5 _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes RLNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes OLNo
❑ 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 A No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q 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 [N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes &I No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [?�No
❑ NA
❑ NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
fallo
❑ NA
❑ NE
❑ Yes
JKNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
[:]Yes allo ❑ NA ❑ NE
[:]Yes RNo ❑ NA ❑ NE
❑ Yes jallo ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,INo
❑ 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120I S Continued

l~ acili Number: r- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 10 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes JZ- No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JS No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�LNo
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
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
r/1 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone:
Date:
21412015

— �- /a /s—
d
Type of Visit: tECompliance Inspection O Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: Q�outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: [� Departure Time: D •3�� County: �*-� Region
Farm Name: /'; ��� ��rr/!tf Owner Email:
Owner Name: 7~„ 4 / fJ��� Phone:
Mailing Address:
Physical Address:
Facility Contact: pn ; Title: jij y/ Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: / 2�4 Al
Certification Number:
Longitude:
Design Current
.{a Design Curren#
Design Curren#
Swine Capacity Pop.
-...
� Wet�Poultry Capacity Pop. Cattle
Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da'y Calf
Dairy Heifer
Feeder to Finish
' «' 'I..
- Design Current
Dr.31,11Ponlf e Ca aci P,o
La ers
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other ';
Turkey Poults
Other
Other
-
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ o ❑ 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): �C
Observed Freeboard (in): 7 L� _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes allo
❑ 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 [allo
❑ 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 MNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ® No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes ® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ® No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 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): l',p /`h �K�h y-�� tr6y-.,�� S��Yi7�lQ / �U�✓Srs-f
//S��
i
13. Soil Type(s): l
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 [:]Yes ELNo ❑ 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
R_No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FNo
❑ 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
F-2 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
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P�.No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

a
Facili Number: jDate of Ins ection: /j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F�6 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes 5D No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes 5jNo
❑ Yes Zj No
[:]Yes jn-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 5;�122 33- -0
Date: e- 2'gy jS
21412011

ivisioa of Water Resources
Facility Number ®- 42/ ©O OtoAfyilandWateftGonservation
hnS
Type of Visit: w�ompliance Inspection Operation Review O Structure Evaluation O Technical Assistance
t6 Reason for Visit: I outiue O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j j Arrival Time: /,'D Departure Time: / ; v D County: Region: 4"'/ O
Farm Name: /�; �y'� I71 Fa g2 j' Owner Email:
Owner Name: /yf�; s Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �� Integrator:Lly
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
I ILayer
I INon-Laver
Cattle
Dairy Cow
Design Current
Capacity Pop.
rn
Wean to Feeder
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , PoW Ca aci Pao ,
Layers
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Qther
Other
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C5No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 CondAued

[Facility Number: - Date of Ins ection:
Waste Collection & Treatment
f 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VI 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): / g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes [a 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 ® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [A No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lb9. ❑ 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
CR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[gNo
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes K] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - / Date of Inspection: — -- /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check 10 Yes [] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Ea Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: �� ��/3 - -
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes IV [—]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [] No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes D No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments(refer to question #): Explain any YES answers and/or any additional..recommendations or any other comments
Use drawings of facility to better explain _situations(use additional pages as necessary). .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: ay /
21412014
Page 3 of 3

- Division of Water Quality^ I3
Facility Number - / `j} OO Division of Soil and Water Conservation % �L
OO Other Agency
Type of Visit: Crtompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / 3 Arrival Time: D Departure Time: © County: Region:��}
Farm Name: ve �Q•' HT Owner Email:
Owner Name: 7_syy /j��7'� Phone:
Mailing Address:
Physical Address:
Facility Contact: 7 pp y %%'f r s Title: i}Lur+G r— Phone:
—7
Onsite Representative: _.�_ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design• Current"'
Design Current
Swine
Po P-
Wet Poult .
t7'
x ,F�
Ca�` ac► Po
p�:_,:w
Cattle Ca aci Po
P ty p.
La er
:P�ty
Dairy Cow
Wean to Finish
can to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , Paul
Ca melt P...o',
Non-Daiy
Farrow to Finish
La ers
fers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
-
Gilts
Boars
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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
[::]Yes
[]-1,To
❑ NA
❑ NE
Page I of 3 21412011 Continued

Wacility Number: jDate of Inspection: IQ/3
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):L�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ 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 4 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 allo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 4 No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [E[ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ®. No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ,ElNo
❑ 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): r/I C 6!/1¢
��i�s�vlse r.r.rSY>�
13. Soil Type(s): Au Ir— Ad: -go�
14_ Do the receiving crops differ from those designated in the CA WMP? [:]Yes 4�g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4S� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes M No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18, Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
4-No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
[DNA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes No
❑ NA
[] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: 4- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
❑ No
❑ NA ONE
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 stmcture(s) and date of first survey indicating non-compliance:
;z0 I_3
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 4 No ❑ NA ONE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to.question# ): Explain any YES answers and/or any additional recommendations orany other -comments.
Use drawings of.facility tob"eiter explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �`r� Phone: %Tp-y3 3�33
Reviewer/Inspector Signature: �� Date: 13
Page 3 of 3 21412011

IN
/ L �� _
3sion of Water Quality
Facility Number` ®- g' O sion of Soil and Water @onservation
© OthBIWA
er Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: J / b Departure Time: County: Pi— Region:
Farm Name: 1 Owner Email:
Owner Name: / fJ q Phone:
Mailing Address:
Physical Address:
Facility Contact: r��/1';S Title: Phone:
Onsite Representative: Integrator: /'�s� �.—
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Current
-
Design ¢Current' Design . Current
Swine
�l'��
Capacity Pop.
Wet Po
Ca
Cattle Capacity Pop.
Wean to Finish
Layer
I
-_
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
17
Dairy Heifer
Farrow to Wean
jWk
Design Current
Dry Cow
Farrow to Feeder
D - P,oult ,
Ca & :" l?o P.
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
} 1 g:
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ® No DNA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �&No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: jT- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. lfyes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: j- �5-- Lr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Callo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes [&No [DNA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[RNo
. ❑ 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
RA No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
jRj 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
E3,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window T
Evidence of Wind Drift ❑ Application Outside of Approved /Area
12. Crop Type(s): r�pf ✓� � /J�%� 61��inr / `a'
13. Soil Type(s): � Z(f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
4 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
Q No
❑ NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
JZ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [—]Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L2g.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VL No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA []NE
Page 2 of 21412011 Continued

Facili Number: Date of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑,No
R
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ja No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes f4No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
-Yes �a ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question#): Explain any:YES answers and/or any additional recommendations or any other, comments
Use drawiags.of_facility.to better explayn situations (use additional pages as necessary)..
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
21412011

Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral 0 Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Q Departure Time: 1 County 0 - Region:
Farm Name: �Z�� �70 %%1 �Grf%?�f Owner Email:
Owner Name: 7—azi6e Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Scar-c.�` Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current _- �.. Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Non -La -Layer
d
g
Dairy Cow
Wcan to Feeder
Dairy Calf
Daia Heifer
eeder to Finish_
- Design Current
Farrow to Wean
Dry Cow
Farrow to Feeder
x.
D � , Poult Ca aci P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Turke s
T
Uther
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 FgNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]yes [:]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
gLNo
❑ NA
❑ NE
[:]Yes
[3—No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 6
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 L.
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
RNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
KNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
. 9. Does any part of the waste management system other than the waste structures require
❑ Yes
5g-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[. No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes
J�qNo
❑ NA
❑ NE
[:]Yes
�No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes ,g�No
❑ Yes MNo
❑ Yes Q'No
❑ Yes 5K.'No
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? . ❑ Yes El No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D§No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: -- /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 18No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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 Dq No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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.
JAApplication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes lv � [DNA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes No
❑ Yes C No
❑ Yes EB-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
IComments (refer to question #) Explain. any YES answers and/or any additional recommendations or any other comments:
lUsse'.drawingsof facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: $�yP_'3:33
Date:
21412011

Type of Visit CirCompiiance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Q16utine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 0'" i?O Departure Time: (] County: Sr' Region: D
Farm Name: _LZLj2L-- /V , � Owner Email:
Owner Name: / /l t/ Phone:
Mailing Address:
Physical Address:
r
Facility Contact: _RI i! Title: (�/iJ�7�l� _ ._ Phone No:
Onsite Representative: S -�� Integrator: �072t�
Certified Operator: Operator Certification Number: Z4
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c = d =" Longitude: = ° =' = u
Design Current
Swine C►apacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
❑ an to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
Feeder to Finish
Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
ElNon-Dai
El Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Pullets
❑ Boars
El Beef Brood Cowl
❑ Turkeys
Other
❑ Other
Number of Structures:
❑ 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?
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 EgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
[g-No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
OTNo
❑ 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): 12 1 $
Observed Freeboard (in): 31,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
(R 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
ANo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[&No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0- o
❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1;4-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) ywe
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19 No
❑ NA ❑ NE
15. Does the receiving crop andlor land application site need improvement?
❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[No
❑ NA ❑ NE
Reviewer/Inspector Name W-- Phone: ¢/f yam_ -3 1D0
Reviewer/Inspector Signature: Date: / D
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2PNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otber Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
EdNo
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
{]C No
❑ NA
❑ NE
❑ Yes
,[No
❑ NA
❑ NE
❑ Yes -9 No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
B-No
❑ NA
❑ NE
Additi
onComments and/or -Drawings.'
A6
Page 3 of 3 12128104

Type of Visit ()-fampliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (koutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �! /_ j`r Departure Time: r�0 County•- Region:
Farm Name: 1'I Owner Email:
Owner Name: .e is Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _—� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0= d= u Longitude: 0 0= 4 = µ
Desigt
Swine Capacity
Curren#
Population
Design Current
Wet Poultry Capacity Popnlation
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
airy Cow
❑ Wean to Feeder I
❑ Non -Layer
I
I
a' Calf
Feeder to Finish I q1,47f9j gV1 7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PE01 Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑Non -Layers
❑ Pullets
El Turkeys
❑ Turkey Poults -
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowi
Number of Structures:
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
V .No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
71
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�3 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�allo
❑ NA
❑ NE
other than from a discharge?
12128104
Confinued

Facility Number: Date of Inspection -D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
$allo ❑ 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
Structure 6
Identifier: �a
Spillway?:
Designed Freehoard (in):_ /
Observed Freeboard (in): qq
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ 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
I& 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
KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
(LNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside offAcceptable Evidence ofWindDrift ❑ Application Outside of Area
lCrop WWindow )❑
12. Crop type(s) l _ Il►'`n Oil LI-e 1 Ifs L„i,., 4 lI,z vit / S�suw.�.ri� 1W' +�" . A / 77Y/ W" 9165"-In
13. Soil type(s) 24:14 X
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
K No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JK No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
t& No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
5d.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
D..No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r� � f�kJ 11 ,-0� Y l � (- Pm w d r aa'q r+�0
/� d9yrc �
`` -II.
Cal e_&f✓L a,7 Z �e �s _ M�wTy,���o��,�{s��rt '7 S*-W
oF7- is O
1W
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: �_/1191 __'71ePa5;1
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E9 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
C&No
❑ NA.
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
54 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
X No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®.No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PA No
ElNA
❑ NE
Comments and/or Drawings:
12128104

2
Type of Visit Owen-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 491foutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 17�� Departure Time: . Q County: Region
Farm Name: r-i A' /� L / 'i �S Owner Email:
Owner Name: Y! ///GZ/ TH j _15 Phone:
Mailing Address:
Physical Address:
Facility Contact: 7iN V Title: Phone No:
Onsite Representative:-- Integrator: 422� _
Certified Operator: �SQ'���- Operator Certification Number: / S'�! _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 = 6 = Longitude: = ° = 1 ❑ u
Desi n , Current
g#�
Capacity Popul 1�,° .
Wet Poultry
Desi nft Design Cu
g Current rrent
Capacity Poplat�an* Cattle Capacity Population
an to Finish
rPSZ
❑ La er
❑ Dai Cow
an to Feeder
❑ Non -La er
❑ Dai Calf
der to Finish
`�-- Dairy Heifer
Farrow to Wean
Dry Poultry
- - - - ❑ D Cow
❑ Farrow to Feeder
- ❑ Non -Dairy
ElFarrow to Finish
110
❑ La ers
El Beef Stocker
El Gilts
❑Non -La Non -Layers
❑ Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Co
O#her�P�
i
❑Turke s
❑ TurkeyPoults
I
❑ Other
,
❑ Other
Number of Structures:
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
[-]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
[]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA.
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PINo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NNo [DNA ❑ 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): 17 / %
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
J?j 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
E,No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Wo ❑ 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 J&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 Pond ing ❑ 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)
13. Soil type(s)
v4,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
54 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VQ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
VINo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
aer explain!
Reviewer/Inspector Name I i �'"� Phone:") 6133-3�5 0
Reviewer/Inspector Signature: Date: ao""
. s6c .. J .� .�.�wvT .J..............

Facility Number: — Date of Inspection —
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f5r-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ANo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbrcakcrs on irrigation equipment?
❑ Yes
allo
❑ 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
P,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
151-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 tithe of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R1No
❑ 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
$2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
54 No
❑ NA
❑ NE
�-..� ,.-. ,.='fir._ ... • , ... .. �-�
AdditEonal Comments andlor;Dra�ings:
i
T
Page 3 of 3 12128104

sion of Water Quality
Facility Number O Division of Soil and Water Conservation 7-9`D7
Q Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d Arrival Time: t� Departure Time: [•L-[- L,M County: Region: a(L
Farm Name: ��s'- Z!tt •_le/iz -rn 5 _ Owner Email:
Owner Name: _ on y EL1_ Phone:
Mailing Address:
Physical Address:
Facility Contact: T12n y's Title: Phone No: ` ��SS�a�6
Onsite Representative: Integrator: _P_rgn ,l
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e =' = Longitude: [=] ° =' = u
I Swine
Wean to Finish
Wean to Feeder
.Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Layer r I
- - — — I - - - - 1 _LQ Non -La et
Dry Poultry
Non-L
Pullets
Turkey
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
❑ Dairy Cow
ElDairy Calf
❑ Dairy Heifei
EFDry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Dumber of Structures: . L
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 (galIons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. 1s 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 CONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1K No
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
11/18104 Continued

Facility Number: — Date of Inspection 7
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3� 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9 No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
M 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
Z No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J4 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
NNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � YiKi =�Al .4er �L/'ota,�5�_,"r3
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ENo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
V 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
[3 . No
❑ NA ❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 57eve Phone:
Reviewer/Inspector Signature: Date: — a
12128104 Continued

y Facility Number: Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19 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 appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. KYes ❑ 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
[3 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EA No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
64 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
9 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
K 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
fR No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f9No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

vision of Water Quality
Facility Number/9 ff0N&
ivisionil and Water Conser.ther Agency
Type of Visit ompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Dfo Arrival Time: ; p0 Departure Time: ; d D County: Region: / WO
Farm Name: r"iQ f Owner Email:
ff
Owner Name: /2&175/ i-.c ,,Phone:
Mailing Address: _ A� D 7 mr>5 e L- Y ✓ r L j >7 fia +'�- AC r
Physical Address:
�
Facility Contact: / Or�-t Title:
Onsite Representative:
Certified Operator: A&.9
Back-up Operator:
Phone No:
Integrator:r,�l..� _.
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 n E--] ' E__1 Longitude: 0 0 = ' = u
ign
CurrentIII
DesigSwine
acity
LN5
Population
Wet Poultry Capacity Population
❑ La er
Cattle Capacity Population
❑ DairyCow
to Finish
to Feeder
❑ Non -Layer
❑ DairyCalf
r to Finish dL
❑ DairyHeifer
w to Wean
Dry Poultry
❑ Cow
w to Feeder
❑ Non -Dairy
w to Finish
EE
❑ La ers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
El Beef Brood Co
❑Turke s❑
Turke Poul
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
E, No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
A No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
M No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R_No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12129104
Continued

• Facility Number: — Date of Inspection
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E-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
[XNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
DR 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
IM No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VQNo
[DNA ❑ 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
WNo
❑ 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s) W a / fi
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 acre determination, El Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
Reviewer/Inspector Name _ - Phone:
Reviewer/Inspector Signature: �' Date:
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 al] components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Dq No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jr No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E&No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[LNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C&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
10 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
R No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PQNo
❑ NA
❑ NE
Additrooal CoEnmeiiis,d/dr Drawings::
12128104

Division of Water Quality !y gx
boty Number O Division of Soil and Water Conservation
I Q Other Agency
A
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: IrIWI-Y-1 Arrival Time: 9: S/,>r Departure Time: County: _Sanya:A�j— Region: fed
Farm Name: �� Owner Email:
Owner Name: /- oPhone:
Mailing Address: :SG G 7 tfo,v)
Physical Address:
Facility, Contact:
Title:
Phone No:
OnsiteRepresentative: Integrator:
Certified Operator: d ila*fA;s _..� Operator Certification Number: 1746
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =' 0" Longitude: ❑o ET E= u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
__ I h ❑ Non -Laves
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
. 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
❑ DaiEy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E;El
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
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
12128104 Continued

Facility Number: s/ 2 — •219 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[R 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: _25%, —Y
Spillway?: _//-/4
Designed Freeboard • ��/Q
g (in):
Observed Freeboard (in): �..2 ~ 470
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
(9 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 AnnlicatiDn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U] No ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? I f yes, check the appropriate box below. ❑ Yes © No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
SG
12. Croph'Pe(s) /s,4 /Aj&- s�i�
13. Soil type(s) _ W4 6--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (K No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[50 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
m No
❑ NA
❑ NE
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date:

Facility Number: oZ —1219 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [)0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge`?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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 Reviewedfnspector 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
9 No
❑ NA
❑ NE
Additional Comments and/or Drawings: `
N c. V— o v r d1. -F r p r-. QI GO w.] ajAA r\ -►q I S1 t P 4 C;A '- o N
PtAr.+ips+�q DGr ri+� IhV��C„ ih rGC'A�G�.� WGS as8 1 C'j'1 br��-�o►ti S �CG4�'
S+..+ceQ k-,3 P17,2 9to P%
029- 5p5k'C_ ,_24V% p.-GAI&C-c— A. -X_ GA4e" . CI:C�N a,,1�cw.�r �1,�,.qt.�� -0.t
Gwti �„yyv� vP #o r c�rir-dr u • c�rs��. �a-�C. i►. s+�dq� o�
CIA-1,.,_4 l�� 6 Ma+C .
12129104

Type of Visit 0 Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit IbRoutine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilin. Number Qatr of Visit: —_I Time: �Ud
':'ot Operational 0 Below Threshold
Urermitted O'Certified0 Conditionally Certified © Registered Date Last Operated or above Threshold:
Farm !Name: _. T_r , �gJ & /*I. _ Count.: _S M&O",
Owner Name: Ror!/J.'� /►%alSF rPhone No: 21 U ; L ?2 - 2!f'72
Mailing _address: _5'607 Ma" - A�e,
Facility Contact: __ iens7%.[ a lr. S _ _ Title: PhoneNo:
Onsite Representative: e n,L p Integrator: te51la4 C
Certified Operator: Ro 0 ,1. e llle'ea,k Operator Certification number: G
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 0� Longitude '
Design Current
Design Current Design Current
Swine Ca acid• Population
Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Laver
❑ Dairy
❑ Feeder to Finish
❑ Non -Laver
❑ Non -Dairy
❑ Farrow to Wean
❑ Farm«- to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ goy
Total SSLW
Number of Lagoons I I
Holding Ponds / Solid Traps
Present IILJ LaPoon Area
Discharses d Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ yes B o
Discharge originated at: ❑ LaQoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes RRo
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ) ❑ Yes EiNo
c. if discharee is observed. what is the estimated flow in Qal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes rB-90
2. Is there evidence of past discharge from any part of the operation? El Yes L� No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �o
Waste C911lection & Treatment �/
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway El yes M� o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! _
Freeboard (inches): [L
05103101 Continued

r Facility Number:
Date of Inspection v�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E44110,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Q<o
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 Mai'
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes E3-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [] Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes gNo
l 1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 91<
❑ Excessive
P/onding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or /Zinc �/ J
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9M
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Bwo
b) Does the facility need a wettable acre determination? ❑ Yes E3'Wo
c) This facility is pended for a wettable acre determination? ❑ Yes &M— , .
15. Does the receiving crop need improvement? ❑ Yes 8-M0
I6. Is there a lack of adequate waste application equipment? ❑ Yes @dO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 8'N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ Wo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Silo -
Air Quality representative immediately.
Reviewer ector Name
Rasp �..
/�i���ll.
Reviewer/Inspector Signature: Date:
12112103 Continued

i Facility Number: o� _' Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ V*qT eheck o, desip-map�tc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboar Waste Anal ❑ Soil Sampli2&,
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ Yes
B.Na-
❑ Yes
❑.Ado
❑ Yes
O-Na
❑ Yes
LWo
❑ Yes
®-Nb
❑ Yes
ado
❑ Yes
P'Ko
❑ Yes
Ellgo
8-es ❑ No
❑ Yes NkND
❑ Yes Km
❑ Yes [�o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes B.Nitr
35. Does record keeping%f NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑#o
❑ Stocking Fo: ❑ Crop Yield Form- ❑ Rainfa O Inspection After 1" Rain-�
❑ 120 Minute Inspectic ❑ Annual Certification FonX_
12112103

ii ivision of Soil and Water Conservation Other Agency
A�
m Division of Water Quality
Routine 0 Complaint 0 Follow-up 7 MV2 ins ection 0 Follow-up of DSWC review• 0 Other
Date of Inspection
Facility Number f
Time of Inspection Z i 3d 24 hr. (hh:train)
r] Registered Wertified 13 Applied for Permit Apermitted 0 Not O erational Date Last Operated: ..........................
Farm Name: .... -1- o -d t..... tC ...... Fnm S ............................ County:...v.?.C'. v 5 all ......................
OwnerName: .... l--w-!1!�.................... ..L..:..j.4.4.... 5...................... ... Phone No: s9—.-.717.�-......................................
Facility Contact:..-. I.. ¢ . . . ....r !
... ca... .s......----•..------... Title: ..1.9.�].Ae.r............................ Phone No: ...�-4,......
Mailing Address: -�.................................. L�- !1'!.. �`- iJ... CT .......I.--••-. ......
Onsite Representative:. ...... . ....... q L' o ............................................... Integrator:... f r'C ..J - -c. ...........
Certified Operator,_ .�r�_a �. [ 0.' Lt .............................. Operator Certification Number :.......... _.............................
Location of Farm:
S.R.,...1 t*4�(Q.�.... Q ' _. .. lkk �►�•..N...,..••••..........................................................................................................•••••.••.•••••...............-...............•. .
Latitude 0• �` `° Longitude
,Current^ -` ",� ign
Des%Current
;Somme Capacity Population; PoultryCapac�tyPopulatiou ^.Cattle g,Capacity Populattnn "
❑ Layer M " ❑Dairy
❑ Non -Layer ,ay ❑Non -Dairy
❑ Other.
-s F� b. - -..uy Y
Total Design Capacity„ Z 70
y YR Is
Nt mber of I agoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
211,
❑ No Liquid Waste Management System
General
❑Wean to Feeder
;�
Feeder to Finish
7. a
-�
❑Farrow to Wean
El Farrow to Feeder
�=
El Farrow to Finish
—Gilts
"4k
El Boars
1. Are there any buffers that need maintenance improvement?
2. is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon ❑Spray Field. [I Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Snrface. Hater? (If yes. notify D1i'Q)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3_ Is there evidence of past discharge from any part of the operation?
4_ Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4 maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ONO
o
❑ Yes
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A(No
❑ Yes ANo
❑ Yes ANo
❑ Yes 0 No
❑ Yes *o
Continued on hack

f
w
Facility Number: ; — 2
8. Are there lagoons or storage ponds on site which need to be property closed?
Structures (Lagoons,11olding Ponds, flush fits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: ... 40..IV.4°..ki ......_q.R ...
Freeboard ft /
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes )KNo
❑ Yes
KNO
Structure 5 Structure 6
......................................................................
❑ Yes
0 No
Oes
O No
XCes
❑ No
Waste application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...........................•-•--..
/-e
16- Do the receiving crops iffer with those desi-nated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement'?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22- Does record keeping need improvement?
For Certified or Permitted Facilities Onlv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes C.No-
❑ Yes KNo
.................... ....................................
❑ Yes
`No
Cl Yes
;NT0
❑ Yes
VkNo
❑ Yes
XNo
❑ Yes
[No
❑ Yes
P(Vo
XYes
❑ No '
0 No violations or deficiencies. were noted -during this'visit..You.will receive no further
correspondence ab.out this:visit:
❑ Yes IN(No
XYes ❑ No
❑ Yes O(No
Comments{cefer.to question#):,Explain any -YES answers and/or aniy recommendaltons or any other comments. "
Use drawings of facility to `better explain situations (use additional pages as:necessarv}
g�f 9r a:5 36 7mtJ OF%_ inside 57/V e a-F Old jaj06,0-.--1V `
Co►kloa-�- ero5fa�•
S 22•-4Zf No ir6 xVloor.,_ fGc-o4s ctuou�aril�•
J Cufi f a.t� w�O�Qw.� 4L� ca.olB Coiw�Ylen�S.
t,c.. Le)e4j laJocr- )eves rec-rds.
7/25/97
Reviewerlinspector 1.. a J'VamC m
a3y y' av : cag"
Reviewer/Inspector Signature: Date:

Facility Number:-.L
f� Division of Environmental Management
I Animal Feedlot Operations Site Visitation Record
Date: /z
Time: 1 _
General Information: I IV-
-4 3 y�
Farm Name: �� 44 l- - /�_ _ �
Owner Name: o Phone No: 1" 2 - 797 2
On Site Representative: 4t1 Integrator:_
Mailing Address: 5-6 o -r►'1-o s e l
1^ AJC- 2932Y
Physical Address/Location: %U /h Z-- 6 CA 4l'
ell,
Latitude: Longitude: 1 I
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer ❑ Dairy
❑ Nursery 0 Non -Layer 0 Beef
❑ Feeder _
OtherType of Livestock in. Number of Animals: ��� y �6
Number of Lagoons: Z (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1-foot + 25 year 24 hour storm storage?: Yes ❑ No Q--�
Is seepage observed from the lagoon?:
Yes ❑
No Q--
is erosion observed?:
Yes d
No U--
Is any discharge observed?
Yes ❑
No]�
Q Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes Cl
NoP—
Does the cover crop need improvement?:
Yes 0
. No
( list the crops which nef improvement)
Crop type: Acreage:
Setback Criteria
Is'a dwelling located within 200 feet of waste application?
Yes Cl
NoU--
Is a well located within 100 feet of waste application?
Yes ❑
Vo ❑— -
Is animal waste stockpiled within,100 feet of USGS Blue Line Stream?
Yes 0
No CI—
Is animal waste land applied or spray irrigated within 25- feet of Blue Line Stream?
Yes ❑
No
AOI — January 17,1996

Maintenance
Does the facility maintenance need improvement? Yes a No ❑
Is there evidence of past discharge from any part of the operation? Yes ❑ No ❑
Does record keeping need improvement? Yes d No a
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No 0
Explain any Yes answers:
Signature: Date:
cc., Facility Assessment Unit Use Attachments if Needed
Drawings or _Observations:
,
`Z/73h --
AOI -- January 17,19%

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor p E H N R Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
DIVISION OF MWIRONMENTAL MANAGEMENT
Messrs. Tom, Tony,
Triple M Farm
Route 4, Box 322A
Clinton, NC 2832E
November 21, 1994
and Ronnie Matthis
SUBJECT: Compliance Inspection
Sampson County
-- Dear Messrs.-Matthis: -
on November 17, 1994, 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 questions regarding this matter, feel free to contact
me at [phone].
Sincerely,
400A_-'
Grady Erobson
Environmental Engineer
Enclosure
cc: Facility Compliance Group
Glenn Clifton
Wachovia Building. Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX 910-48&0707
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

NORTH CAROLnuk DEPARTIUM OF . HEALTH A NATURAL RESOURCES
DIVISION of AL lANAGffiffiQT
Fayetteville Regional Office
Animal Operation Compliance Inspection Form
Tom, Tony, and Ronnie Matthis I I
11/17/94 341
Triple M Farm
Route 4, Box 322A
Clinton, NC 28328
All questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the deemed Permittee to perform the appropriate
corrections:
Animas operation
Horses, cattle, , poultry, or sheep
so-MON II
1. Does the number and type of animal meet or exceed
the (.0217) criteria? [Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid waste
system)] --.
2. Does this facility meet criteria for
Animal Operation REGISTRATION?
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a QMTIFIBD ANI1AL
WA= jMM Gffi WT PLAN?
5. Does this facility maintain waste management
records (Volumes of manure, land applied,
spray irrigated on specific acreage with
specific cover crop)?
5. Does this facility meet the SCS minimum
setback criteria for neighboring houses,
wells, etc?
rye�
inn=
,NEI=
Iff
Not
requ red

SECTIOR III
Field Site Manaaemgnt
1. Is animal waste stockpiled or lagoon
construction within 100 ft. of a USGS
Map Blue Line Stream?
2. Is animal waste land applied or spray
irrigated within 25 ft. of a USGS Map
Blue Line Stream?
3. Does this facility have adequate acreage
on which to apply the waste?
4. Does the land application site have a
cover crop in accordance with the
CERTIFICATION PLAN?
5. Is animal waste discharged into waters of
the state by man-made ditch, flushing system,
orothersimilar man-made devices?
6. Does the animal waste management at this
farm adhere to Best Management Practices
(BMP) of the approved CERTIFICATION?
7. Does animal waste lagoon have sufficient
freeboard? How much? (Approximately _4 ft._)
8. Is the general condition of this CAFO facility,
including management and operation,
satisfactory?
FA
Comments
MOM
_�%
OEM
IN=
IN=
IN=IN.=
This facility is not required to have a certified waste management plan until
1997. A cover crop is already established and grazed by cattle. This is a
well organized and operated facility.