820229_INSPECTIONS_20171231

NQHTH CAHOLINA
Department of Environmental Qual

�L-J
rvisian of iW,ater Resources
Facility Number - Z.2 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: �6mnliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C outine 0 Complaint C) Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: u,
i Arrival Time:[. ITT. P I Departure Time: � County: S. }i(�S 1j) Region: F��
Farm Name: i' C�1/ W(�S Owner Email:
Owner Name: /VC I S t' 1 '2 r je f Phone:
Mailing Address:
Physical Address:
Facility Contact: Cu=�1_5 j3 ad--&_ �Ce Title: Phone:
Onsite Representative: j( Integrator:rs
Certified Operator: E15 r �- Certification Number: 17 0 �O
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Curjr
gnim
Design Current
Swine
Ca pacity Pop.
Wet Paultry
Cacity
at;
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P.oultr.
Ca acit
Po
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
[3 Yes 0 o []NA ❑NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ED 'V U
❑ Yes No
Q-?q-A ❑ N E
f'�A ❑ NE
E3'NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: - 22-Date of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural, plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;LNur❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q A ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
�-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[D-Ntf ❑ 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
Q-110 ❑ 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
Q-?To' ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E?fo ❑ 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 [Zj N ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EDIFlo 0 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 n ❑ Evidence of Wind Drift
ft ❑ Application Outside of Approved Area
12.Crop Type(s): m ��e.� J (90 PtX.,, C ill
13. Soil Type(s): 1,Y!:;5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E]_W6 ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes [g-NU ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0<o
❑ 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
[3' o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D—K6
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[T'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
❑-II
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
0 Yes
Qfi')Q
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 'Z2-7 jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]-W ❑ NA ❑ NE
2S. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
J�❑ 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/[nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes [4,WO' ❑ NA ❑ NE
❑ Yes G ol�❑ NA ❑ NE
❑ Yes Q� No ❑ NA ❑ NE
[] Yes [5-go— ❑ NA ❑ NE
❑ Yes e�- ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Yes o [` NA
❑ Yes �Ie- ❑ NA
❑ Yes [D-MY- ❑ NA
Comments.(refcr to I question#) Explain any YES'answers. and/or a'ny additional recommendations or any other comments.
I1se.drarvirts of faciiity;to,better'*explain'sittistians;{use,adciiktonal pages as necessary).
1-7 � r
G.eV Rl0-3 Dg--�esl
J � ,
to r erlaA.
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name: A3 t ( Q U y t44 p Phone
q(Q- Lf.3 3 -33V_
Reviewer/Inspector Signature: Date: f L UA44
Page 3 of 3 1 21412015

T-4 AA w
(Type of Visit: QrCompliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 'Z[ Arrival Time:' Departure Time: r �� County:
Farm Name: f ~ l
-- ! L f 4t- Owner Email:
Owner Name: N "L5! 10 fir Phone:
Mailing Address:
Physical Address:
Facility Contact: [�(j wfit Y [� �✓ WtuTitle:
t�
Onsite Representative:
Certified Operator: eD ✓- I rV_
Back-up Operator:
Location of Farm: Latitude:
U Region:[ 1. _o
Phone:
Integrator: 1t e S
Certification Number: I-7 F-Z
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
airy Cow
airy Calf
Wean to Feeder
Non -La er
Feeder to Finish 00
7 40
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D � , P.oult
Ca aei
Po
Non -Dairy
Farrow to Finish
La ers
4.1
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
7
Qther
Turkey PuultsNENMM
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?
❑ Yes IS'YO ❑ NA ❑ NE
❑ Yes ❑ No �A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
E37RA
❑ 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
D No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F]�No
❑ NA
❑ NE
of the State other than from a discharge`?
Page I of 3 21412015 Continued

Facility Number: ,� - 941, Date of Inspection:
Waste'Collectlon & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-Nb--o NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E5-N­X--❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes ("{- ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E�<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 eNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes [J 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 [/ No ❑ NA ❑ NE
maintenance or improvement'?
Waste.Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes [:5No ❑ 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 rWiindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V �L! t- /Zy ..e- _e
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 fNo
[:]Yes [v]No
❑ Yes E] No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑Yes �No
N ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ Yes 0'' 0 ❑ NA ❑ NE
❑ Yes Er�lo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes [�6o ❑ 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 E2*'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faciliq Number: E- Date of Inspection:
24. Did the faciaity fail to calibrate waste application equipment as required by the permit? ❑ Yes-- K(o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [2-fs►o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑"No ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
dNo
❑ 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
ffNo
❑ 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
dNo
❑ 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
dNo
❑ 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/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3 No
❑ NA
❑ NE
34. Does the Iacility require a follow-up visit by the same agency?
❑ Yes
[2/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 additionah pages`as:tecessar ).
Ca,(tLriti
5
P-o-3.6
Gyt( Vo-joC off(
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 nf'3
Phone:[, 0- #:J '✓'
Date: 3Yql 11
2/4/2015

lvlsion of Water Resources
Facility Number I w� .J - � ---I O DIVIsian of Sall and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: C0I4outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access rr��
Date of Visit: Arrival Time: Departure Time: r County: Region: I
Farm Name: 1µS Owner Email:
Owner Name: [ S� , `� Phone:
Mailing Address:
Physical Address:
Facility Contact: C1414-74c.a {���y� Title:
Onsite Representative: C[./
Certified Operator: N-166 o" o o"-f en
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:` iC
Certification Number: 17 F7 _
Certification Number:
Longitude:
Deslgn Current
Design
Current
Design Current
Swine
Capacity Pop,
Wet Poultry
Capacity
Pop-
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
%
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oult ,
Ca eci
I:o
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes © ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ®-No
❑ Yes 2"Ro
[:]Yes [I] No
Q'IVrA ❑ NE
EJXX ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is (Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E 1q tJ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 3-1qA [] 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
❑.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
U "'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
[t l�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
F--Ko
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[;I<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[nNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑-o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): IriL_ - SGc�,✓
13. Soil Type(s): LIyytG(k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [4*No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [fNo ❑ 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
ET.'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
YNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ r; o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes f No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24..DW 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 2-5o ❑ NA '❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 [; o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
;;,4o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E
❑ 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
[3No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
!Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to ruestion #)xplam a'ny;Y>JS answers and/or.any additional recommendations or. any other,comments ,
iJse drawings.of facility. -to betfer'ez Iain,situ' dons (use`additiol ages as necessary).
Up
Ste- z
Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:931±f,
21412011

r194ER s_Z�
Division of Water Quality
' Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Glioutine 0 Complaint 0 Follow-up 0 Referral 0 EmerEency 0 Other 0 Denied Access
Date of Visit: (r„ Arrival Time: OD Departure Time: County: CS y%i
Farm Name: r✓ Owner Email:
I N
Owner Name: 1,40 LK � -� w'} Phone:
Mailing Address:
Physical Address:
Facility Contact:
bC " Title:
Onsite Representative: f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Region: l
Phone:
�j
Integrator: /►�
Certification Number: 17P,�
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non-LayerI J
Design Current
Dry Pnultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Daia Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑#A ❑ NE
❑�NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No E3*"'TIA ❑ NE
2, is there evidence of a past discharge from any part of the operation? ❑ Yes r No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [l'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9-Ko" ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:)Yes [:]No C]-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): A v a_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �No[] ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
'o
❑ Yes [2 1Vo
❑ 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-Ko—
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes G3No
❑ 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): t'1,tt_vt.� C�5W`p_
l
13. Soil Type(s): L jAf'k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [= 110 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes to ❑ 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
[f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
lJ 0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
do
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E(N o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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
o NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZrNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

>F'acili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [fFlo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2,-Qo ❑ 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 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?
❑ Yes <o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Q-No [DNA ❑ NE
❑ Yes [] 9o_ ❑ NA ❑ NE
❑ Yes [D o
❑ Yes [D o
❑ Yes E] No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to, question #): Explain.any YES answers and/or any additional recommendations or. any other comments.
Use drawings of facility, to;better.ex'lain situntions (use additional pages as necessary).
C�j q q-j �l
- � P
� 16
-*Z - 0 - 3. 3
C
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t 1,228142%MMA�..'�
Phone:
Date: �� ��l►�
21412014

Type of Visit: mp ance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I I ► r ! 1 I Departure Time: County. 44n4
Region;
Farm Name: _r_zLV tiki Owner Email:
Owner Name: iV fit$
Mailing Address:
Physical Address:
Facility Contact: A.,G-y'(` (
Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator: 42 el6l) Certification Number: 1_7424_0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current°
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop
Cattle
Capacity
Pop.
Finish
Layer
Dai Cow
Feeder
Non -La er
airy Calf
o Finish
airy Heifer
o Wean
Design
Current
D Cow
to Feeder
Dr P.oultt,
Ga aci
P,o
Non -Dairy
Parrowto
to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
t" _
Beef Brood Cow
Turkeys
Turke Poults
�4
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No AA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ??` ❑ Yes ❑ No C31 A E3 NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes EY o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Epcilivy Number: Date of Inspection: 5121,6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [-<�_E] NAB❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []"1VA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[] ❑ 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 [j Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� 000 0 NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
04]Io ❑ 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
[]fqo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[E'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): co i
13. Soil Type(s): ro
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Epft ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [DA'6'_ ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [Z?IVo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes `, DNA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes LJ '� ❑ 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? 0 Yes °f No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ko ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilljy Number,: Date of ins ection:
9M
. 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes LJ No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes Rio ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes �I�`❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes E>e--[] NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑.Ale— ❑ 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 L TT"" ❑ 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 [3-laid ❑ NA ❑ NE
permit? (i.e., discharge, frceboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 2 o E] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes N/o ❑ NA [3 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ l�l "'90 Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 6_1�0 ❑ NA ❑ NE
omments re er toquest on ). Expla n any YES answers and/or: any additional recommendations_ or any other comments.
Use drawin s�
g ';of facilit to better explaim.situations (use additional pages as necessary).
CAI ( dA_ r` 6-(1-1z_
A
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phon
V�
tec*Nd
2/4/2011

Onsite Representative:
Certified Operator: N>~\gpR ?Omu,
Back-up Operator:
Location of Farm:
y,
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 0 Denied Access
Date of Visit: I a Jvt Arrival Time: 1 & . p Departure Time: !�!I od �M l County: �A- rr�� Region: ViAh
Farm Name: Pi d rq of ,S Owner Email:
Owner Name: 1VF1,Srin1 A 0 Kd? Phone:
Mailing Address:
Physical Address:
Facility Contact: �p,�� S p{� r. y�Title: 1 &C) —rCAI q�IJ���t� Phone:
r
` Integrator: tj
Certification Number: 11 g"l
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry wil-acit-V311111111P. Cattle Capacity Pop.
Wean to Finish
I
La er
Non -La er
LDai
Dairy Cow
Calf
Wean to Feeder
Feeder to Finish 70D
50
�'
airy Heifer
Design Current Dry Cow
Dr, I;oultry Ca Aei Po P. Non -Dairy
Layers Beel'Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
rTBeef Brood Caw
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes [:]No &NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
[Z A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[o
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: 1AA I Date of Inspection: H 25
Waste Collection & Treatment
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
G211NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z)
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
EZ"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 2No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? []Yes [�rNo ❑ 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 [vZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E� 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 WindDrift❑ Application Outside of Approved Area
12. Crop Type(s): GjkAzr m m e R t 6u L;s i M I I £T
13. Soil Type(s): ch 4-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2f No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[StNo
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have
the to the Certificate of Coverage & Perrot readily available?
❑ Yes
[�(No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[SINo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [] Design [] Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
0 A
0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
[:]No
A
❑ NE
Page 2 of 3 21412011 Continued

. ti
Faciii Number: - a• I Date of Inspection: -5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []/ 'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ f No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo
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.
X Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [v7No ❑ NA ❑ NE
❑ Yes qNo ❑ NA [] NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes [ No
❑ Yes [� No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to. uest�on xp a n any
y YES answers and/or ,any additional recommendations or any other comments
Use drawings. of facility to bette
r explain situations Luse additional • panes as necessary).:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q\c)-a)G%-U%SI
Date:
21412011

I
Type of Visit: om liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: erRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /6 Arrival Time: r Departure Time: County: Region:
r
Farm Name: II Owner Email:
Owner Name: �V , Phone:
Mailing Address:
Physical Address:
Facility Contact: � u� t, Title: I iLi d Phone:
Onsite Representative: �G�rl�r�-v���ir� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
- Design Current
Swine Capacity Yop.
Dea_19n Cur e�nt #'
Wet Poultry Capacity Pop Cattle
Design'
Capacity,
@urgent
Wean to Finish
Layer
Dairy Cow
Wean to FeederEINon-Layer
^', Dairy Calf
Feeder to Finish
Ql) ''"
Daity Heifer
Farrow to Wean
Design Gurreist D Cow
Farrow to Feeder
Dr, P■oultr> C:a licit I;o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
O_tlser
OtherI
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
Io
❑ NA
NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
ErNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
&<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
E2,1 t'
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
k; o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
to
[] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit y Number: - Date of Ins action:
Z[i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LLet"1"�
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
LJ ' A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:`
Spillway?:
Designed Freeboard (in): //
Observed Freeboard (in): All —YV
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[! ' o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E 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
FEr�4o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z,No
❑ NA
0 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
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L`. Ko ❑ 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 Evi ence of Wind Drift ❑ Application Outsidef of Approved Area
12. Crop Type(s):
13. Soil Type(s): k1 ih uu
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑'416'
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[]I- o
❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
[! No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
D 'VV
❑ NA
❑ NE
Regulred
Records & Documents
�,�
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
It o
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[54o
❑ 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 IJ'wo ❑ 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 23'No ❑ NAB ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3 No ©DIVA ❑ 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 Z]� ? " ❑ NA ❑ NE
25. 1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes' lf�O ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
❑ Yes CU.Atts__'❑ NA ❑ NE
❑ Yes ❑ No ❑ NA
[]Yes 1_`31lo ❑ NA ❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EI-'lQo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
❑ Yes
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
Lf No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�
[] 4 o
❑ NA
❑ NE
Reviewer/inspector Name: 4.4 vyI-fir Phone: l/U — 33—j
Reviewer/Inspector natur Date: )
Page 3 of f 3 21412011

ivision of Water Quality
7aci.ty Number ®- O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up O Referral O Emergency 0 Other' O Denied Access
Date of Visit: Arrival Time: 14Departure Time: / County: Region:
Farm Name: �-'1 Owner Email:
Owner Name: �C?� Phone:
Mailing Address:
Physical Address:
Facility Contact: CL�s &e'C.o Title: Phone:
r Onsite Representative: Q l f- .¢�ttr � Integrator: _ M_r 6
Certified Operator: 04tislfY1UV'' Certification Number: I q �P
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0 Yes �o ❑ NA ❑ NE
❑Yes
❑No
2 A
❑NE
❑ Yes
❑ No
211vA
❑ NE
❑ Yes
❑ No
Q-<A
❑ NE
❑ Yes
[t�'�10
❑ NA
❑ NE
❑ Yes
[2<o
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment �,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Kj 110 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ild46 ❑ 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
2'`'o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
lid""
❑ 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
Q'1Vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F.Ko
❑ 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
1ld o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[R' oo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [a'1Vo ❑ 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): �C.t.�.l 5 1 � � :S%-L L&Ltt,.Q--T et�•)
13. Soil Type(s):
1
14. Do the receiving crops differ from those d0signated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D o
❑ Yes
[t J "o
❑ Yes
io
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes L71�o ❑ NA ❑ NE
[:]Yes to ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
I o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E '`'o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[]110
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[:]No
❑ NE
Page 2 of 3 21412011 Continued

lFacility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E]<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q,<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [J<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
03<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
f[ ?10
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
[26No
❑ NA
❑ NE
33, Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
��rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[911 o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional.recommendations or..any other. comments:
Use drawings of facility to better explain situations (use additional pages as necessary). .._ k, ,gjr.�,
-Z, �C" r-L 4VV%� 6-j A-�� Carp->r
Gr� F�_V_ *%A-
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone: Q —
Date:
/2011

1��Aus 2 -dS- 2-010
ivision of Water Quality
Facility Number i �2Z O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0'fo­mpliance 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: %-29-%O Arrival Time: f Z ; 0I Departure Time: County: ,Sa.++pSa� Region: FAD
i
Farm Name: E 5 1=0' ys't S Owner Email:
Owner Name: /1t a lso"i I O 1" 'tv'r Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: _.711:11 • Sleer_ Phone No:
Onsite Representative: Ckv4i's BdLvvsic le_ I integrator: C0 tncty' f- r`a ✓',, S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Cur4l s RaYwr'e..K
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e = 1 Longitude: ❑ ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑Other __..
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle. Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ED
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes
❑ No
B A
❑ NE
❑ Yes
❑ No
D<A
❑ NE
EJ iVA
❑ NE
❑ Yes
❑ No
❑ Yes
B-1\lo
❑ NA
❑ NE
❑ Yes
E3'i o
❑ NA
❑ NE
12128104 Continued

Facility Number: 92 —ZZ9 pate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CTNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ErNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
3 o ❑ NA ❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
ErNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes
BNo ❑ NA [:IN E
(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
[ <o ❑ NA ❑ NE
maintenance/improvement?
I I. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
ErNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > I0% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Fe-SCUe. (GArm3e—) Su+tilLv�cr {�i�lfcv �iNN �f
13. Soil type(s) L, n/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENNo
[INA
[IE N
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
B"'NNo
ElNA
ElNE
17. Does the facility lack adequate acreage for land application'?
El yes
3<
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B o
❑ NA
❑ NE
Cn: l I'
om>f.: Vr tqP taY:S`.nswcs'ntllomdtiments (reeaons or an.0
y other comments
Use drayvtngs of facility to better explain situations: (use additional pages as necessary):
00
Reviewer// nspector Name c K zV [.15 Phone: 9�o 5�3333
Reviewer/Inspector Signature: R Date: % — L 9 _ 201 D
12128104 Continued

r -
Facility Number: 82 — 2Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L"J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
®No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections 0
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
03 No
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L"J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BINo
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3//No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o
❑ NA
❑ NE
Other Issues ,_,/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LJ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONNo
❑ 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
L1No
❑ 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
L7 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
ILI.No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
[ff o
❑ NA
❑ NE
12128104

7.T044.5 /0-05-2007
Type of Visit EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit GHroutine O complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
DateafVisit: I~/%��9 Arrival'1'ime: ��40 Departure Time: �`�S ICI County: `s�t"t�sON Region: Re
Farm Name: J...._.Fa y Owner Email:
Owner Name: /rIe-l-cON ror-� Phone:
Mailing Address:
Physical Address:
Facility Contact: Ctkv4t3 13avw►1 G k Title: Ph/one No:
Onsite Representative: Integrator: Co4ak4t Aieow_r
Certified Operator:
Back-up Operator:
Location of Farm:
0
Latitude:
Operator Certification Number:
Back-up Certification Number:
Longitude:
Design C►urrent
Swine Capaci
Design Current
al Poultry Capacity Population
Design Current
Cattle Capes clty Populatlon
❑ Wean to Finish
JE1 Layer
❑ Dairy Cow
ElWean to Feeder
❑ Non -La er
El Dairy Calf
eeder to Finish 12700
12
El Dairy Heifer
ElFarrow to Wean
IDry
Poultry
❑ Layers
Non -Layers
El Dry Cow
ElFarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
❑ Pullets
❑ Beef Brood Cow,
Number of Structures:
❑ Turkeys
❑ Turkey Poults
Other
❑ Other
❑ 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 ❑<o ❑ NA ❑ NE
❑ Yes ❑ No 3<A ❑ NE
❑ Yes ❑ No [` �A ❑ NE
❑ Yes ❑ No $1VA ❑ NE
❑ Yes 2,�,<[] NA El NE
El Yes L11o' ❑ NA ❑ NE
12128104 Continued

11
Facility Number: 82 — ZZ9
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
❑ Yes No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39
37
01
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes C No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes LT No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) E�/
9. Does any part of the waste management system other than the waste structures require El] Yes !_ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement? �,,/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElL7
Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Area
12.
01
Crop type(s) o . 5 ri e rGv-a 3 e_) 15WWW4er 71W,
1 /
13.
10
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[I NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
m o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Nc
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
xt�t.:.,j ,i+_T 1�4]" l r�fi.:-: 'fa„ T.Ip,:.'"r ,FrrM-',:'�,r,�:2 -'" V A 1 }�„ p,. - _.r.
Comments refer to F
( question'#) .Ezplatn"aav YTS'answers and/or any recommendntions ovany other comments.
�. .. ra t#N' "a rt r5�
Usc drawings of fac.ility,to !letter explain situations. (use Additional pages as ifecesSaltj � � }
Goo 4 grc ss o N Lasoo" dp' I<<.S �
•
r,> '
Reviewer/inspector Name / e.rj/C1:7%' �„ {• Phone:
%IO, *.33 #3-3-3
/G
r,,�
Reviewer/inspector Signature:
Date:
9-/7- ZOD q
12128104 Continuer!

Facility Number: 82 Zz`j I Date of Inspection
Required Records & Documents eNo
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropriate box. ❑ W UP ❑ Checklists ❑ Design ❑ Ma s ❑Other
p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
fo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections [I Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�+, NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
LONO o
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
015o
❑ 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
BINo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
office 31. Did the facility fail to notify the regional of emergency situations as required by
Yes
[IL
,� '
Ko
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Now❑
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
f
L'�'f�10 ❑ NA
❑ NE
12/28/04

gJ iv 3 V-zY-oB rr
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Ghfoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 8--13-0Arrival Time: Departure Time: /: z5` County: .sQ,f-Psa✓ Region: '_'A040
Farm Name: 'S Owner Email:
Owner Name: IV elS.0/✓ !"©r THY' Phone:
Mailing Address:
Physical Address:
Facility Contact: GU,0-_A S 84k-41rCI C Title: /�c�� .SOS . Phone No:
Onsite Representative: edrC r S E4 k'j1; K Integrator: CD 1 d Yi, < Car S
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 i 0 « Longitude: = ° ❑ 4 ❑
110
Desi n Carrent Desi n , Curren e ' t �'�
g K��$ DesigCu
on
Swine Capacity Population Wet Poultry Capacity Po la' Cattle�'��"
p ttl � 2ZCapAcity Populatton .
� . ., � ,:
❑ Wcan to Finish ❑ Layer E ❑ Dairy Cow
❑ can to Feeder
10 Non -Layer
1
1
❑ Dairy Calf
® Feeder to Finish
Z 700
`Z ❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
eef Stocker
❑ Non -Layers El Beef❑ Beef Feeder
❑ Gilts
ars ❑ Bo
Pullets
❑Beef Brood Cow
;I IEl
Turkeys
Other
❑ Turkey Poults
❑ Other tN imber of Structures: L
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
L7 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
El No
,,��,,��
ElNE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
,LTNA
L71vA
❑ 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
i111A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
B-9—oo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D 1qo-_❑ NA
❑ N E
other than from a discharge?
Page 1 of 3
12128104
Continued

� r
Facility Number: �2 ZZ�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure
Identifier:
Structure 2 Structure 3 Structure 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 40 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑YesL'1No ❑NA ❑NE
[:]Yes L3No ❑ NA ❑ NE
Structure 5 Structure 6
[]Yes No ❑ NA ❑ NE
❑ Yes 3 o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes O'�10 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes l_Vo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0-No []NA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes l_dlvo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑-N—o_❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 4:2 Gc4 e_, LC� ►-c3 t) SuPq^ee_e z t j�& k, A.✓il1 u
13. Soil type(s) LN
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [-,�oo El NA El NE
15. Does the receiving crop and/or land application site need improvement? El2 Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes Br'4o ❑ NA [:IN E
17. Does the facility lack adequate acreage for land application? ❑ Yes 0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2<o ❑ NA ❑ NE
Comments (refer to question-#i); Explain any YES answers and/or any recomm�cndattd�hior.any other comments.
rawin6s of facility to hatter ex1:1plain situations. (use addittanal pages as ne
Phone: 9/O Reviewer/Inspector Name J�,.T" :c e ; 5 5�33 3,� 0
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continuer!

Facility Number: SZ —7Z9 Date of Inspection 3—O
Required Records & Documents ,_,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 03"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes l3No ❑ 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
eNNo
❑ 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
E oo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E J/o
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
_❑
E o
❑ 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
LE No ❑ NA
❑ N E
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
D'Ho ❑ 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
D<o ❑ 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
ErNo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No ❑ NA
❑ NE
Page 3 of 3 12128104

s
Fadhty Number; 8`�• zZ gOviw�_ton ofcSoil andWater Conservation
m y
v�seon of Water u
�Nc +-OfOthYer A�gencY' .
Type of Visit • Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q-08- 4 Arrival Time: %2'30 Departure Time: County: a Son/ Region:
Farm Name: _ F71kV Owner Email:
Owner Name: IMSaN part✓ Phone:
Mailing Address:
Physical Address:
Facility Contact:�� 5 134rW1t.<< Title: Phone No:
Onsite Representative: ,Cults. ;gayyjt jL - ___ Integrator: -a e--
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Design Current
Swine Capacity Population
.r-, - -. . .
Ll Wean to Feeder
Feeder to Finish 27D0 2 82 3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: = Q ❑ 4 = Longitude: ❑ o = 6 = «
Design Current
Wet Poultry Capacity Population
❑ Layer
jU Non -Layer 1J
Dry Poultry -:..
Pullets
LJ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity: Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes R No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
J� No
❑ NA
❑ NE
12128104 Continued

s
Facility Number: Date of Inspection I 1d-0$-07
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes (� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
� No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Wo
❑ 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
Q9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�No
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
7 No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below,
[--]Yes
[NNo
❑ 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) �cam GM t e
13. Soil type(s) Aj
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
5 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]
Yes
(9 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA El NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
R 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. (useadditional pages as necessary):
Reviewer/Inspectnr Name Rick `fie, e s Phone: DO, el33,3300
Reviewer/Inspector Signature: &LeL Re-nA� Date: /D -Or-„?QUO 7
1-111461v4 uonrrnuea

Facility Number: $2 —ZZq Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (A 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 ❑ 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
P] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
X No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PE No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�j No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2� 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
[X 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
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: QS 10-06 Arrival Time: Departure Time: County:
Farm Name: P �� //� Fd ,01 _S Owner Entail:
/t
(iwnor Mimi- /e,/Soul Phnnw
Mailing Address:
Phvsieal Address
Facility Contact: /V e_lson/ All' c4— Title:
Onsite Representative: _CL yk.5
Certified Operator: O- 1t-r 9,
Region:
Phone No:
Integrator: Go �(2%4 t.
Operator Certification Number: / 7974v
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other
❑ Other
Latitude: = o = 1 Longitude: = ° = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
j❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharnes & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
'Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
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 [9No ❑ NA ❑ NE
❑ Yes
C9 No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
❑ Yes
29No
❑ NA
❑ NE
[--]Yes
®No
❑ NA
❑ NE
12128104 Continued

lki
r-
Fgrility Number: $Z —ZZ9
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes (NNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: o r (L - N
Spillway?:
Designed Freeboard (in): 191,
Observed Freeboard (in): ']9n I!Ses44c.Ld-2Vj_) 5Ro
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
[A 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
(�l No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[A No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
19 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[gNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
CM 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) Fe Sr=jjG►ra
13. Soil type(s) L >riA16A/Duv4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
CR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
UNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
[RNo
❑ NA,
❑ NE
-: "s ♦ i4-` 'h 1 !f ka�. e
Reviewer/Inspector Name 1� ° ` ,r d�N .:! Phone:
Reviewer/Inspector Signature: Date: /Q — Z DO <o
12128104 Continued

1
�4
Facility Number: 8L —Z29 Date of Inspection 5_—/0-06
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes (2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EA No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, 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
[I No
❑ NA
❑ NE
El Yes
RNo
❑NA
❑NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 20 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes JE No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes [VNo ❑ NA ❑ NE
y - g,�y 1 F �a,.
Addltio"nal Comments;and/oryDrawings
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Foilow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 f IS/di Arrival Time: %3 o Departure Time: County: Say--nsoti Region:
pt
Farm Name: Y r_ s Owner Email:
Owner Name: N lsnr► - ��_� �1 c� ____ Phone:
Mailing Address: G z al r ce-4- r�. �_ (geov_e
Physical Address: d N �✓� ��: c �_ /�. 1i c'Q �e �,j j&y.0 U r& J c
Facility Contact: 'Title: Phone No:
Onsite Representative: Cq .-tis f f�rw i r� L1Lcr_l �s
Certified Operator: 1AJ { t w_r
Back-up Operator:
Integrator: �grte
Operator Certification Number: _/7 2 7-(e_
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 ` Q `! Longitude: ❑ ° = 6 = It
Design Current. Design Current -
Swine Capacity Population . Wet Poultry. Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish .270o a�G
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other `
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle` Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 71
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
12128104 Continued

Facility Dumber: - ,7�� Date of Inspection 3 //7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V] 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 [Z No ❑ NA El 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 Drifi ❑ Application Outside of Area
12. Crop type(s) /%7:
13. Soil type(s) ,t'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R No
❑ NA
❑ 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 acre determination'[]
Yes
[Z No
❑ NA
❑ NE
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
7— WOrk C9r.
i
rte Ck c�reri
1
4{%t Cb+44C
OfJ,
LM
viewer/Inspector Name
[Reviewer/Inspeetor
a r
a /c
- Phone: it ° 'L/J-G - /.S-i'/
Signature:
Date: O:S'
,�
12/2"4 Continued

Facility Number: $a -2Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (A 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
® No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit? ?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NI,
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
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 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
No
❑ NA
❑ NE
12128104

Type of Visit (KompjL3ace Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit "outine O Complaint Q Follow up p Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: Dv
0 Not Operational O Below Threshold
tted ertified Cj Conditionally
"� Certified © Registered Date Last Operated or Above Thresholdle
Farm Name: .........Nt...r.....!......... ��e•!e............[...t T....�"!"`�.......................... County:...».......� Y!............»....».............. .........
....,
Owner Name: .....
... ,(.lt:.15p.VA ....... p ac ia.............
...................................
.........
.'..........`..`. Phone No:.... .I.. ..............I ..................................................
Mailing Address:.. A� .....�g'.Lt��... Sr..........................................................1 !Ta!'`.. & ...1".Lj ......... .... a ARC ............... ..........................
FacilityContact: ....... .................................................... .............. .... Title
:................
...
...................................
.....
..... Phone �N_o:..........................
......
........
...........
Onsite Representative. ,._....�` !, .....&,...... !�Ir.!�;;:t:.»...::..........I.................."I....... Integrator:..........�� 10 i ... s:........................
Certified Operator: ............................................... ... ....... . .
. ................ ..........................................?...? i...........
Location of Farm:
(] Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude • 1 «
Swine
❑ Wean to Feeder
a-fieeder to Finish
a p
o
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Non -Layer I
Other
Zvi.,
Discharges & Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'?
,� De$rga E i Current ;;
i .Cattle ,` ,a Ca ace :, Po Mahon
�+ ❑Dairy
❑ i Non -Da
i� ry
r�i1 i-''17 Yt�11Y i�Yj�?�ir a i4•'
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ofiqr�
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No/
❑ Yes ❑v
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [.Nv—
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......................................................................................
Freeboard (inches): 3 13
12112103 Continued

Facility Number: ; —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN_ ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &FrMhdA . . PA r-st i
13. Do the receiving crops differ with those designated in/the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes S'N'o
❑ Yes E<O
❑ Yes CTNo
❑ Yes EIN6''
❑ Yes Duo
❑ Yes Leo
❑ Yes �
❑ Yes
M44T'
❑ Yes
❑ Yes
0- o
❑ Yes
El-Ro
❑ Yes
ff 10
❑ Yes
Em
❑ Yes [3-Pd6---
❑ Yes ['-}'qo---
❑ Yes 5446--�
❑ Yes LII0
�: 'ai�4iiliYiiFl:t`.tsfFt:P.CMG:.••'"i^S.4ie�tfl3.Yis1-_3,r.i�i'i: Ei,. ;iiifPcli�'°��"1 I;;%i%'@'�Yi'
`'Comments (referlto:questton #) Explain any Y Saanswers and/or any recommendations oVany o r commefiW",�;
jw....�
Use,draivingslof fadiity�tolbetter'expla�n ;situapoas `(rise addittbaal�pages as necessary) jI geld Copy ❑ Final Notes{'
r
/��,, y ll i� I I
Reviewer/Ins ector Name , g!!�,F �,i M
p C..�?'I.L�
Reviewer/Inspector Signature: Date: i D
L
12112103
Continued

' Fac ity Number: — Date of Inspection 9%
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes CTI o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? ,���
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes En'rro
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Leo/
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
fit}
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
,,., ,�
(ie/ discharge, freeboard problems, over application)
❑
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
��°�
L�'iQo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
B<o
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
MY es
3I.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,❑� �No
L�'1vo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[RQo
33.
Did the facility fail to conduct an annual sludge survey?
21fe—s
❑ No
34.
Did the facility fail to calibrate waste application equipment?
G-Y—es
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
34?6'�'
❑ Stacking Form ❑ Crop Yield Form [:]Rainfall [:]Inspection After V Rain
12112103

REGISTRATION FORM FOR ANIMAL FEZOLOT OPERATIONS
Department of Environment, health and Natural Resources
Division of Environmental Management
Water -Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2F.0217 (c) in order to be
deemed permitted by OEM. Please print clearly.
Farm Name:
Mailing Address:
County:
Owner (s) Name:
Managers) Name:
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
mi leoost etc.) : e s e12 wjo !>
6 g%� U n U rm.r 23 -kLi Rio �,
Latitude/Longitude if known:
Design capacity of animal waste.; pnagement system (Number and type
c; confined animal (s)) : �e
Average animal population on the farm (Number and type of animal (s)
raised) . a-4-CO F--6j .S , ,Cl__kCa
r
6-�VV g
Year Production Began:l9 7 ASCS Tract No.: �v
Type of Waste Management System Used:lrI f 0�,
Acres Available for Land A li
tion of Waste:.
3 s
Owner (s) Signature (s) :
�ZL
DATE:
DATE:
i 'y c j.s-s `. rra
*a h t
/I/C. 155
L6 le s T&I
/pima W1. �Z- /` . (e
,�-

WTff
- at rm
IFM ZITT nil'n
7m
TFrr
nrr
um
arn
4-a
AUDI
�4ffr
WT 7m
YM
4
I Wr ct,
iisT
e.
ra
TM
zzli
TM
TM
Hirt
ri
TM
'ZM
FMffYf
YM
vm
TM rm Im TM
Or
Tm
Tin q—n.W f.
2vqrL
TM UM
,-
3m TM 6 Twk tail
rM
er
r1FT
r,2T .4. FM TA
im 19 WWI
GUT rR k r. m AOMO NO1AN30,14
TM
7147 t
e
MIT rM YM
0 e ME TM
rr,
EM
tot tot
ir
kW-
!:Tf 't TEW It Tu'T
5m
TU,
TM et 'IF TM
ril
T W, TM TM -ri I sMtivj ....
UZI Trzi
act,
11 IT,
fm YM TC21 m rk
TO D pr it
TM 'k w
o.
w j.d.0 OfT.
w svj f.
IT-41
If
vs 'L 4F ilTl'
v Ape
TIM
OW-1 TM
vc
r. TM
512 r
m 7
of m TUT
T
V o.
FM A 0
tiL
t, 4:1
str
pr.fe
—TP

Site Requires Immediate Attention: _ NP�
Facility No. _82- aza
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 av , 1995
Time: � �: ys
Farm Name/Owner: ?
Mailing Address: z%(a 1 St. ntw,�'Ce Carr NC.
County: Sc�c,R�svN_
Integrator: C.o b,0. C 1 a.- Phone: 0 %.05
On Site Representative: He \so., Q.''tar Phone: `k ks SRy - o o rp% T
Physical Address/Location: 4 li.—/ So +S5 7— N o zs.
%/a- f%. _ rZ•.E.. �3 k.' Z SV_ 4a
Type of Operation: Swine Poultry tattle
Design Capacity: o:> Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) P�a�gon(s)?
or No Act Freeboard: 3 Ft. Inches
Was any seepage observed from theNo Yes o Was any erosion observed? Yes or No
Is adequate land available for spray? Yes r No Is the cover crop adequate? Yes or No
Crops} being utilized: t-,k- *t r ��ler �55 �. � �.. n...rs av4.l�bt�,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwell' Ye or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(F)
Is animal waste discharged into water of he state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management reco s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: Z iioi l a < <,, ' 3 Fk frct 6,..,, t
U-/ -2. F k rj 4 it i .J 4r mok a S 'To �- o �• i R LA cavc► W S %"' NJ
SIL f2ti LZ
L%,C 1 g- :�RvS�r_ _ ` O O v'1 k 1 1 Ct
4" .-Y,-C` W, ,1c.Cr
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.