820234_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental qual

type of visit: 0_ ,ebmpliance Inspection V Operation Review V Structure Evaluation U technical Assistance
Reason for Visit: Q, outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: v K Arrival Time:f Departure Time: County:
Farm Name: e 6" dG c Q Owner Email:
Owner Name: (y �jti° K G Phone:
Mailing Address:
Physical Address:
Region:,]�C
Facility Contact: L & o,_4 15 ✓`GU( Title: Phone:
Onsite Representative: ( Integrator: 'J s
Certified Operator: 17 rLWL i k A- Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
Dai Cow
Da' Calf
Wean to Feeder
o2 0d 5
Non -La er
Feeder to Finish
Design Current
D . P,oultr Ca aci P,a P.
Layers
Da' Heifer
Farrow to Wean
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
I
Beef Feeder
113eef Brood Cow
Boars
Pullets
I
-
Other
Other
urkeys
Turkey Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes EK. ❑ NA ❑ NE
a. Was the conveyance man-made? [:]Yes [—]No [31 A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes ❑ No Q 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 DWR) ❑ Yes ❑ No [3<A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ff No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - 2 3 Date of Inspection: �u
WastilUilection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PD- o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t1 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [n it 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
❑.N'6- ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
I-1"O
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ET5o
❑ 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
❑--Ncr
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[q-IT'S
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes a 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): C i3 -a Iu_ 5'6-0
- -
13. Soil Type(s): e-a-- 4 Z-�> r� os
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Cg'% ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [a o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E 'go ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes []'No ❑ NA ❑ NE
[:]Yes [2-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [ N ❑ 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 [allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [! No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [a -No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ONE
Page 2 of 3 21412015 Continued

Facili Number: - Z- [Date of Inspection: L­f_/ tw I
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 [C]. -iKo_ ❑ 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 ❑1\lo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3 1`'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[0,Wo
❑ 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
Z °V 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
0<0
❑ 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
O 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
Q'50-
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑'No
❑ NA
❑ NE
[Us mmentsrefoe"r to quesµ #j: Eap >nny YESanswers :and/or any additional recommendations or anylottier cofirtments.
e diawen f�iacil�ty to beiter explarn_ situations„ use d i 6nal:pages`as uecessary). * `
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3of3
Phone: T o— q.3 J
J
Date: 7 `j u LAe
21412015

Type of Visit: 0 Co
Hance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [, m Arrival Time: J Departure Time: f�'•0 County: Region:
Farm Name: IY l� �`1 a� 1� Z Owner Email:
Owner Name: Phone:
,Mailing Address:
Physical Address:
Facility Contact: Cu. u 6 s 19 �✓� Title-
Onsitc Representative:
Certified Operator: Ccu✓t✓L-S
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: H +J —S II
Certification Number: 19 W e? *L'
T
Certification Number:
Longitude:
...................
Design' C•unrent
Design Current
Design Current
Swine Capacity Pop.
V4'et Poultry
Capaci Pop.
Cattle Capacity Pop.
Wean to Finish
I 11-ayer
Dairy Cow
Wean to Feeder IUL
Non -La er
I
Dai Calf
Feeder to Finish'
° x " `=
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D , P'oult ,
Design Current
Cam aci Pao .
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
-
Qther
Turkey Poults
Other
Other
Discharges and Stream impacts
I . Is any discharge observed from any part of the operation?
[]Yes
[B-1q_o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
�A
❑ NE
b. Did the discharge reach waters of the State`? (If yes. notify DWR)
❑ Yes
❑ No
[]-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
<
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El Yes
WNI
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412015 Conthrued

Ifacility Number: - 9. Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q'No
❑ NA
[] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway`!:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E]"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
Q�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
Ejr'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ NA
D NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2' Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraalic 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): �✓ ►3l/1 S fn=
13. Soil Type(s):---
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [24o D NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWM P readily available? If yes, check
❑ Yes �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 0/1
❑ 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 214120I5 Continued

Facility Number: 93L - 3 Date of Ins ection: 1h 1 _
24.,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ao ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [r -<_ ❑ 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 E440 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErNo ❑ NA ❑ N$
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZrNo ❑ 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
ETNo
❑ 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
E No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
El"No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments referltd- uestion #) .Explain any YES answers and/or any additional recommendations or any other comments.;-� -;•
Use drawings of (aciliiyto better explain situatians (use additional pages as necessary): - -
CIA P-of 1 .1 4i —1
C,t 'Va- 3v fir- P-5I
Reviewer/Inspector Name: Q t t( 'u:) Phone: Vow tl, 3 `3:3 3
Reviewer/Inspector Signature: UDate:
Page 3 of 3 214,a I S

type of visit: W compliance inspection V Uperation Review t,,,) Structure Evaluation U '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: , V Arrival Timer Departure Time: II/ W County:_
Farm Name: r� 11 A Owner Email:
Owner Name: [.O� (.f� Phone:
Mailing Address:
Physical Address:
Facility Contact: 0tVt 4, Title:
Onsite Representative:
Certified Operator: *qe
Back-up Operator:
Location of Farm:
Phone:
Region:
Integrator: 1�tT 7
Certification Number: [ % 0y 2^
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Wean to FeedeF,
Design Current
Capacity Pop.
I
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
kA7
INon-Layer
D , P,oul Ca aci P,o ..
Layers
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Turkeys
Turkey Points
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑'No - ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [NA. ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No E! NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No <A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [no ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ENo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: .
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2,16 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 64A ❑ 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 [30No ❑ 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 I__I _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 ETNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s): ��n V ► Vc , 16&1 _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E f No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes
C311'No
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
[!rNo
❑ NA
❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes F!rNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E? No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspectionss
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ZNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E Noo ❑ NA ❑ NE
� 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes XO ❑ 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 B-Tgo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CD�Nr ❑ NA ❑ 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
r❑'1Q'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
0 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
[..Die
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3-No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EJ-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C]�No
❑ NA
❑ NE
Commca (refer to gni:shon #) Explaw4siiy Y,EStaaswers and/or any add1tional rec6mmendabans�or any'other coniinents.
•. t f -
Use drawings of fac litytto :better eaplaia situations [use ad i�teoniai4pages;as necessary,}.
2 --t q
swov-C, r6 F�t g
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: � � 3
Date: t
21412015

ZA5 c{ -- 2-1 —1-5- tit
Type of Visit: 0 Cam fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: EY Routine Q Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: J f { UJrF'� fi Departure Time: County: c,L4 Region•` T�
Farm Name: cLA, G-ke- d 'J"-4,3 _;t� Owner Email:
Owner Name: �- Lt Phone:
Mailing Address:
Physical Address:
Facility Contact: C&. 5 1�3 2t/WLrC(f( Title:
Onsite Representative:
Integrator:
Phone:
M6
Certified Operator: j, Certification Number:?
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design' Current Designr ,,.
Current Design Current
Swore Capacity. Pop. Wet Poultry Capacity Pop`Cattle Capacity Pop.
Wean to Finish L
ayer Da' Cow
Wean to Feeder l�.h jTi- p Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean esign Currents . Cow
Farrow to Feeder D . P,pul JFQ
a aci :. 1'0" Non -Da
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets i Ilk Beef Brood Cow
11111, Turke s
Other Turkey PoultspE
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EZ>0'__E] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[3-Nf,
❑ 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
E3 A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q 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 [g-146'�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E I�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [J-I5❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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? ❑ Yes 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 Ia ro ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q--K-o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D 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): 6 �✓c-v�h s�
13. Soil Type(s): g r
14. Do the receiving crops differ from those lesignated in the CAWMP?
❑ Yes
[ZKT
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[B-96
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'l<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-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L3'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stacking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6+Io
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NO
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection:
24. Didthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a-Ido ❑ 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 [3-1qo­ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E],No ❑ NA ❑ NE
Other Issues
/
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
tyJ go D NA 0 NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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
01<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
��No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers -and/or an additional recommendations or any otho, comments' jL'-
Use drawings of facility:to better explain situations (use adtlitiiinaup""ages as necessary),
C",'k C /-f to-1 __ <�- _� --
SL15-e- �-_ , q c)_ 0), --7 P.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

Type of Visit: 0 Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: -1 Atoutine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: A 6kArrival Time: /b Departure Time: County: Regio
&e—
Farm Name: (AAI Owner Email:
Owner Name: A t e, (4 Un Phone:
Mailing Address:
Physical Address:
Facility Contact: Co
Title: : f� Phone:
Onsite Representative: ff Integrator:
Certified Operator: 0'7� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Destgp Current a Design Current
Swine Capacity Eop: Wet�Poultry Capactty Fop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
Feeder to Finish
'= ` " :-
Desi
D .' P,oul' Ca aci P,o
Lavers
Non -Layers
Pullets
Turkeys
Turkey Poults
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non-Dai
Farrow to Finish
Gilts
Beef Stocker
Beef Feeder
Boars
Beef Brood Cow
Qther
Other
Othcr
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes Eg.N a NA ❑ NE
❑ Yes ❑ No [],Nit— ❑ NE
❑ Yes ❑ No QN21C ❑ NE
❑ Yes
❑ No
[AA
❑ NE
❑ Yes
Q-No
❑ NA
❑ NE
❑ Yes
<o
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: d I-4UMTDate of Ins ection:
�i
Waste Collection &Treatment r�
4. Is storage capacity (structural plus storm t rage plus heavy rainfall) less than adequate?
❑ Yes
l�"o
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in) -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Lg-N ❑ 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
[2f-IVo
❑ 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
[ ,b q
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ca*6
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
�'
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L_l o
❑ NA
❑ NE
maintenance or improvement?
I l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DIK. ❑ NA
❑ 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(/'IMtfcta S {�
❑ NE
13. Soil Type(s): �^ S 4
14. Do the receiving crops differ from those designated i the CAWMP?
❑ Yes
-lqo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3-go
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q'l'lo
❑ NA
❑ WE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�'
Q-No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[1 �❑ 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
[3-Ko ❑ 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
[ -<) ❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Err o ❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -24 s ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Na— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ❑-We'❑ 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 ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E�J-W ❑ 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)
❑ Yes Hr ❑ NA ❑ NE
❑ Yes [n-NK� ❑ NA ❑ NE
❑ Yes M-No ❑ NA ❑ NE
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E2:2� ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[—]Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[24'o ❑ NA
❑ NE
Comments (refer to. question #): Explain any YES answers and/or any additi al recommendations or any other comments
.
Use drawings of -facility: to::better explain situations (use additional pages aessary).
5I"va d u-0,a� 3 y I
c'�'� '�'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t
Pha1l v 3
Date
21412011

ivi5ion of Water Quality ���-�5�r�'�r3
Facility Number �� - ,�3� © Division of SoiIN nd Water Conservation
© Other Agency
Type of Visit: UVompliance 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: --/7 Arrival Time: ,' j9 1 Departure Time: County:
Farm Name: z Owner Email:
Owner Name: ��, „HadLy Phone:
Mailing Address:
Physical Address:
Facility Contact: G'v e r;.5 blGyr Title: Phone:
Onsite Representative: �cL.
Certified Operator: !/4hna` � , p
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region: � 0
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Capacity Pop. Wet Poultry
Capacity
... Pop.
Cattle Capacity Pop.
o Finish
La er
DairyCow
o Feeder
loCC
CO
Non -La er
Dairy Calf
to Finish
DairyHeifer
to Wean
Dry1 iiItr
Design
Ca aci
Current
I'o
D Cow
to Feeder
Non -Dairy
ErFeeder
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
lll
Turke PouEts
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page -1 of 3 21412011 Continued

Facility Number: - j Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Stricture 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9'
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
© No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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?
L'es
1No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[@ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JZ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I1 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): _46olm-* IOU
13. Soil Type(s): W01
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V3 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeili Number: - < Date of Inspection: — 7%'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�S.No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fist survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ Yes ®No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Ilse drawings of facility toYbetter_explain situations {use additional pages as necessary).
Comments refer to nestion # Explain an YES answers and/or an additional recommendations ova other comments. }i
Reviewer/Inspector Name:
Phone: 97tt _
Reviewer/Inspector Signature:
Page 3 of 3
Date: ,5-- / 7 d 13
21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q-16utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
F
Date of Visit: I IA 1-1 a, Arrival Time: 10U Departure Time: County: Sd✓\ Region: _FlD
Farm Name: R%M- ] Jf `a. Owner Email:
Owner Name:,! L(N CgN,N Afl�:j Phone:
Mailing Address:
Physical Address:
Facitity Contact: 0_Ulzkss Qmo wv_ k Title: Phone:
Onsite Representative: arw\ — Integrator: M un h�� a)
Certified Operator: �yk+A kv�, P. C{, N W A Ate/ Certification Number: Q QL ,log
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
'Swine Capacity Pop.
Wet Poultry ';'
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
JLayer
Dairy Cow
Wean to Feeder `
iNon-La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , I;oult , _
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
urkex Poults
Other I
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2"No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
[g'NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[jkGA
❑ 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
o
gNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

"i
Facility Number: - Date of Inspection: 11 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2110 [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No OD-14A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A
Spillway?: _
Designed Freeboard (in): j_
Observed Freeboard (in): �r7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes 0­2-'No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ffNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[U4o
❑ 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
EarlL
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
r7Mo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E3 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): { KA-IL
13. Soil Type(s): n
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
[ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Ej No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
2No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
hio
❑ 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
�Io
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[/No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: jDate of Inspection: LA1
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes []� I o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg-'go
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes []2"'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ra'ON'o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Eg"go
❑ 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
[g,"<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
[g"N^ 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
[ a'NOo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ ]Ao
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[]�'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[eNo
❑ NA
❑ NE
Comments (refer to question ,) .Explain any YE&answers and/or any additional recommendations or:any other. comments..
Illse drawings of facility'to tietter explain.situations(use additional pages as necessary).4_..�
01-N 60M_ Zkpo;s Av4zurvo Avp cP 1(.\ joor )
1-.tick of V P-c1-tA4 {m j e q1)p'_"' A RuvrD 9or1 it)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qko-
Date: y Z7
21412011

`61wv-'> -7I / s/// -t-y-
(Type of Visit: O-Co a Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: fJ l Arrival Time: S Departure Time: p County: Region: 5CR
Farm Name: Owner Email: (/
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Title: Phone:
Onsite Representative: ��� Integrator:
Certified Operator: Certification Number: Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
J Design Current Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop: Cattle Capacity Pop.
Wean to Finish
Da' Cow
Wean to Feeder
ENayer
Dairy Calf
Dairy Heifer
Feeder to Finish
.' -`
Farrow to Wean
ty�4.
Design Current
D Cow
Farrow to Feeder
D . P,oul Ca a ty P.o P.
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Turke s
O#her _
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[:]Yes Rio ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes ❑ No
L1 N ❑ NE
u`VA ❑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 VA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes BNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes Fo [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment /�(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [9'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EJ-1QA ❑ 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 property addressed and/or managed through a
❑ Yes 2<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes [v�'NO
[:INA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes - E]'Wb
❑ 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 g2'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
�--,�
❑ Yes [gam l fO
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes [],Po
❑ 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 Drill: ❑ Application Outside of Approved Area
12. Crop Type(s):
�
13. Soil Type(s): lr� / r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L'_J <o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes E]-<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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 52 No ❑ NA ❑ NE
[:]Yes l.LKo ❑ NA ❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
0
❑ 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
0No
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
❑ No
D<A
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes l 2-14 o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 93-7
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refe. twouestion # ):. Explain any YES answers and/or any -additional recommer
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA
❑ Yes [c. <o ❑ NA ❑ NE
❑ Yes 2'Klo ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes
D"No
❑ NA
❑ NE
❑ Yes
[2"No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
D NE
Use drawings of facility to better'explain situations (use additional pages as necessary). A, '� ""�
6
Ob JVL�4k C,_yrXj_-d I &X
Af-c4VA PoA,
Reviewer/Inspector Name:
ReviewerlInspector Si
Page 3 of 3
Phone: /O ` 3,3
Date: /Z
/2011

(Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
ij Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p Arrival Time: l l Departure Time: County: +'1PSOt Region: FRO_
Farm Name:
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address: �h. ,,
Facility Contact: E't^ �"""""`� Title: Phone No:
Onsite Representative: N Integrator: lrUrOw'i - &*UqL'
L/
Certified Operator: ��at �,o'r' Operator Certification Number:�'� o l
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E-1 e ❑ = E—] " Longitude: = e ❑ ' ❑ u
rrent
EM-lCu
Designurrent
Design CCapaciulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
I
I
1 ❑ Layer
❑ Dairy Cow
Wean to Feeder
00
I I
JE1 Non -Layer
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
El Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl
ElTurkeys
Other
_��_JLL❑ Other
❑ Turkey Puults
❑ Other
Number of Structures:
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 1P No ❑ NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes ❑ No (ZI NA ❑ NE
t
❑ Yes NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ERNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 Date of Inspection 7 l0 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
❑ Yes � No ❑ NA ❑ NE
❑ Yes [:]No - P NA ❑ NE
Structure 5 Structure 6
Observed Freeboard (in):
L,?4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q9 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 CpNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes `p No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (mow- a ` rµ..x.�4 ! p_, Cwjt
13. Soil type(s) ­J0Vl In 5--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
T No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[b No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
ED No
❑ NA
❑ NE
Commensrefer n#; ExplaiYES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
4 tA5�►, .
L
Reviewer/inspector Name i ^ �u I';•u ` Phone: 33-33�a
Reviewerlinspector Signature: Date: % 26 O
Page 2 of 3 12128104 Continued

Facility Number: —e2 Date of Inspection 1_7wo
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes H No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes &allo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists Design ❑ Maps
❑ Desi p ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�FNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No JN NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
99 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[PNO
❑ 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
P NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1PNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tfl 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
19 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
[;INo
❑ 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
�1 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[29 No
❑ NA
❑ NE
_ .; " s antllor'Drawm s p -
Addrttonal Commen ,
a
T
Page 3 of 3 12128104

i
[Ry
peofVisit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for Visit 0 Routine 0 Complaint m Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 10 ql Arrival Time: Departure Time: i ounty: `j�W_1 )
Farm Name: ti7�nQ 4l� _ __ _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: SRO
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: d"—,?rVC0t,
J !
Certified Operator: �+ Operator Certification Number: VIM
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e [=' = Longitude: = ° = 6 0 «
Design Current
Design- Cugie n!j
Design Current
Swine
Capacity Papuiation
Wet Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Finish
❑ Layer I
❑ Dairy Cow
Wean to Feeder
tfcao
I JE1 Non -Layer I
❑ Dairy Calf
❑ Dairy Heifer
Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Beef Feeder
❑ Boars
❑El
Pullets
❑ Beef Brood Co
ElTurkeys
- -_ -
Other ,
❑ Other
❑ Turkey Poults
El Other
Number of Structures:
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 4No ❑ NA ❑ NE
❑ Yes
❑ No
Pg NA
❑ NE
❑ Yes
❑ No
UNA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
[§ No
❑ NA
❑ NE
❑ Yes
'H�No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — '1j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1PNo ❑ NA El NE
a. 1f yes, is waste level into the structural freeboard? El Yes \❑ No Q�NA ❑ NE
Stru re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
NPNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
T 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
[n No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
49 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
[RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA IM NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
Ir NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
IP NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
t� NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[ NE
Comments (refer to question #) Explain any YES, ans«ers and/or an. y.recommendahons or apy. other comments
Use drawm s of facility to better explain ns (use additional pages as uecessary
situateo
Reviewer/inspector Name Phone: 3-334D
�r
Reviewer/Inspector Signature: Date: �� O
Page 2 of 3 12128104 Continued

Facility Number: 02 Date of Inspection r
Required Records & Documents I
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 appropriate box. ❑ WUP ❑ Checklists ❑ Design [:3 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?
[:1 Yes
❑ No
❑ NA
a] NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[V NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[11 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
P 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
F1 NE
Page 3 of 3 12128104

Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '—� T7 V Arrival Time: 0V40 Departure Time: Q; County: 5401j Region:
Farm Name: Owner Email:
Owner Name: A Phone:
Mailing Address:
Physical Address:
Facility Contact: fA W'+ Title:
Onsite Representative: l
Certified Operator: Oh {21W 44
Back-up Operator:
Location of Farm:
Phone No:
/y/�
Integrator: `'"tL,%np� W # LLC
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = d = Longitude: = o = 0
eI,
I Z06 fW
Swine
Design Current
Capacity Population
Wet Poultry
Design Current Design •urrent
G _3C i!A Population Cattle Capacity Popuia#ion
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
I 1,CZ0
1 Q
ID Non -Layer
I
I
❑ Dairy Calf
El Feeder to Finish
I
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
ElLa Layers
❑ Non -Layers
❑ Pullets
❑ Dry Cow
[INon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Turke s
❑ Turkey Poults
III0 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 ® No ❑ NA ❑ NE
❑ Yes
tB No
❑ NA
❑ NE
❑ Yes
C3No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Cfl No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
12128104 Continued

Facility Number: gat Date of Inspection
T
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
No
❑ NA Cl NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
T 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
6] No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7_ Do any of the structures need maintenance or improvement? Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence f Wind Drift El Application Outside of Area
12. Crop type(s) 7 U7'tLr�t (/.f�PQ.o�
13. Soil type(s) Wgat-atvt —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments f : ,.: . :. rns oanatheJi
ry . ntsj II 1'' Ih
mm
Use drav►ings of facility to better expiaan situations (useaddeflo al pages as necessarv)r y r�coe +
W py�L o o I9Lt-+�p C+-,�eq S G.✓O l a5ocz vt
ryew-e-e ew a
Reviewer/Inspector Name
-�" `.
c�
Phone:
Reviewer/inspector Signature:
4_Aajk&
Date: D Z it D
12128104 Continued

Facility Number: Date of Inspection !o ZI
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ 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 yNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U@ 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
[�LNo
❑ 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
.91 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[B No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�3 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
09 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
tB No
❑ NA
❑ NE
Additibnal:Cominesits andlaDrawiags:
12128✓04

j
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O ?$ Arrival Time: Departure Time: County: -57qmt Region: JCAP
Farm Name: ew\ Cqn►?Q4 horn, Owner Email:
Owner Name: I'r If_)i 642nn Phone:
Mailing Address:
Physical Address: ,,,f
Facility Contact: � je*j CannA Title:
i�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
I
�J Phone No:
Integrator: I"lamM'tf
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = . = Longitude: = o = t F-1 u
Design C•urre_ut
Design Current
Design Current
ne Capacity Population
Wet Poultry
Capacity P_—Iation
Cattfe Capacity Population
Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
26Ob
Q
❑ Non -La er
❑ Dai Calf
Feeder to Finish
❑ Dai Heifer
Farrow to Wean
IFF-1
oultry
w-
❑ D Cow
Farrow to Feeder
La ers❑
Non -La ers
0
❑ Non-DairyFarrow
to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets❑
Brooder
Turke s❑Beef
❑ Turke PouetsOther ❑ Other
Number of Structures:
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 VNo ❑ NA ❑ NE
❑ Yes ❑ No J9 NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes F) No ❑ NA ❑ NE
❑ Yes PRNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 1B oZ3
Date of Inspection o �$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
6 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
1�1 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �fd
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�8 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
n 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?
91 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JANo
❑ 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
iS No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
19 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 09 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 El Application Outside of Area
12. Crop type�rn
s) �i � � S� lrSl �-t�h� Spn d Gra.r�,, d ty4-
13. Soil type(s) o�v►5 - 'o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [1No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 1� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes IS No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FpNo
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
' r�
Uc mna�ents. j
C T its (refertto�quest,on #} Exp any YES answers an any econnmea lions or any otheov!
ecessary. K): a-
iJse drawsngs oipfactiity to better expiam s�tnatioas:,(nse,aifdihonal pages as nIX
irhtr{ 1 �d �S CL'--re+h deSrSc,c 4zc'
JOi'l�q'i1n�r OTC 000e_-{a-+-r-.
N� 1j;
-1
Reviewer/inspector Name rb Phone: I0`g33-3
Reviewer/Inspector Signature: Date: i Cpl 2 'a$
Page 2 of 3 12,128104 Continued

Facility Number: --234 Date of Inspection UiEikoa
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes PANo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g [I 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 ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
F] No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
§allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ip No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
91 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
In 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
(9No
❑ 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
%No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(&No
❑ NA
❑ NE
Additional-Commeifs;!andlor Driwings _ .... _ „' ..MAX
S u r� pie "0 ✓mil . Plot"
ka 5
�
Cory e G—J
(" S j"d
_
c J 1r4er
ZCOB -Cev- fe.w Bvej)
I. Ie'T ww9 . b" La4-;e aeeO6 a*_o,'u-d lAsa011
V
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit & Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S Arrival Time: 11T Departure Time: a�,�/1,� County: -V S0W Region:
Farm Name: 'Alle4i Owner Email:
Owner Name: Aeel Phone:
Mailing Address:
Physical Address: �7
Facility Contact: `' ICI 94 Title:
e./
Onsite Representative:
Phone No:
Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: ❑ 0 0 I = u Longitude: = ° = E__1 q
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
P[[:l
Layer
Q Non -Layer I EA
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity 'Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No 19 NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No � NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
V
12128104 Continued

Facility Number: 2-Date of Inspection !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard ('
Observed Freeboard {i
❑ Yes M No ❑ NA ❑ NE
[:]Yes [:]No PPNA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 59 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 Q0No ❑ 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 )a No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require [--]Yes Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes [�PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence off_'W��i��nd Drift ❑ Application Outside of Area
12. Crop type(s) , J. r,m+—t 5&-n D� , / Arun+ , A4� Q� A;, -/
13. Soil type(s) Jo - J0kKS4-% vti
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NNo
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
f9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2PNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name JV Phone:
Reviewer/Inspector Signature: Date:
1 L/LO/V4 t-u"99 IllCf[

Facility Number: B9,:23qjDate of Inspection
Repaired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P,9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes ILA No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes O No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes $LNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0No ❑ 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
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
69 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
N 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
to No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Comments and/or Drawings:
l2/28/Q4

Type of Visit ®Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ®Routine 0 Complaint 0 Follow up Q Refers! Q Emergency 0 Other El Denied Access
Date of Visit: Arrival Time: /; pO�¢�, � Departure Time: 2'.Dp County: a Region:
Farm Name: 1-e C 6 N - G # Z Owner Email:
c ei/*910� z/4 - 77/S
Owner Name: A// �.sl _ Phone: -�
Mailing Address:
Physical Address:
Facility Contact: All A) 1_a?A/A/jrz Title:
Onsite Representative: Allen/ A/A/L•
Certified Operator:
Back-up Operator:
Phone No:
Integrator: v/1�� �/'irc�//✓
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = ' 0 Longitude: 0 ° =
Design Current
w'et PoMDesign
urrent
V'P ulation
Design ir—rentlillill
Cattle
Swine
Capacity Population
apaci
Ca aci Po ulation
1P ty P
❑ Wean to Finish
❑ Layer
❑ Non -Layer
❑ Dairy Cow
jig
Wean
El Dairy Calf
❑ DairyHeifer
Dry Poultry
"4
❑ Cow
❑ Layers
El Beef Stocker
❑ Non -La ers
El Beef Feeder
❑ Pullets
El Beef Brood Cowl
❑ Turkeys
Other
❑ TurkeyPoults
-
Number of Structures:
❑ Other
❑ Other
NEW
•.-
to Feeder
a-SSI!7
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
[ffNo
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
M No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
(9 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El yes
(Q No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
®No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
IM No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
11/18/04
Continued

r
Facility Number: Z—z3
Date of Inspection 2'//-8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7_7
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 [9 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes C9 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 [4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M 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 ❑ No ❑ NA El NE
� Yes
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. ❑ Yes Co No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) p " r^j tl e.v t Co rAJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? [:]Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes IP No
❑ Yes [4 No
El NA ❑NE
El NA ❑NE
Comments (refer to question #): Explain. any YESsanswers and/or, any recommendations or: any other comments r f
'Use drawings of facility to better explain situations. (use:` additional pagesas necessary):
Jf y - �`OIVy-1 ill4tvv%-� r w�S SysK *`.t tJCiJ
c ds -& (�jZ C.b ry :/'iI..T:-1. a_sk :]k / Cra o-S Ri�CQ.
4o {q C c k c C K e d c-,j 8 l D ro p e n t) I J C n1 `f �'i Z�/ 1, h[ C J. -1) t J Q FIX r4-. A/ a we to e ;-r N�
r5�5
Reviewer/Inspector Name R �' G�.VI y5—� : f Phone: (`�!f/JU -,330a
Reviewer/Inspector Signature: Date: J Z —/l ` LO 6 (a
rage a of j l I_161 4 u0nn"Med

Facility Number: Z 23 Date of Inspection 2_ ��_" c
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [5No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EN 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
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[A 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
j No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
01 No
❑ NA
❑ NE
Additional Comments andloi Drawings L , e,
t- ✓fit'+w ✓ W G V 1/�.i h1 C+ _ `
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 9 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: t-j- G15' Arrival Time: Departure Time: County: Region: 1?0
Farm Name: Owner Email:
Owner Name: 4 m", - 6"'J n 2G� . -- -- Phone: Gil
Mailing Address: 1I 52zz i,.P_ ,. Aoucl G I Z 04
Physical Address:
Facility Contact: Aden 6,111 Title:
Onsite Representative: Lunn n r/_
Certified Operator:��trt__- r
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: /Ov
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I 0 Longitude: = ° = 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ElLayer
r 7 —U ❑ Non -La ei
❑ Wean to Finish
can to Fe
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry. Poultry
❑ Layers
❑ Non -Layers
I
❑ Pullets
❑ Turkeys
[EllTurke Poults
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
El NE
El Yes
,allo
{� No
❑ NA
❑ NE
12128104 Continued

. .i
Facility Number: J i Date of Inspection y-!4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 1
Spillway?: n U
Designed Freeboard (in): _ Ry /
Observed Freeboard (in): -? :_! i/
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
0-f4o
❑ 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
D No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
['No
❑ NA
❑ NE
maintenance or improvement?
Waste APRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
/
D No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [2To ❑ 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 Dri$ ❑ Application Outside of Area
?'75-
S
12. Crop type(s) e
13. Soil type(s) ill,(
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UNo ❑ NA ❑ NE
15- Does the receiving crop and/or land application site need improvement? ❑ Yes Q'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[:] Yes ❑ No ❑ NA ONE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA Ej! E
18. Is there a lack of properly operating waste application equipment?
❑ Yes Q No ❑ NA ❑ NE
ReviewerlInspectorName /11dl;"k: Phone: <1/0 -`7�C
Reviewer/inspector Signature: tYl�,,,/� /� t,r„ u _ _ Date: `j ILI 0
12128104 Continued

• t
Facility Number: 3 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Et"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [es ❑ No ❑ NA ❑ NE
the appropirate box. Opp ❑ Chists ❑ D 'gn ❑ Map's_' ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Wasto..4pphieetien L' Weekly Freeboard ❑ ElSea�r ElWastcc -�rs Elr/
04ainfall I Stocking ❑ Crop Yield ❑ 120 Minute Inspections D<onthly and 1" Rain Inspections ❑ Weather-evd'
22. Did the facility fail to install and maintain a rain gauge? E es ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA O'1QE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[ENE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
2-NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[a- o
❑ 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[1�o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[TNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ERNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
DNo
❑ NA
❑ NE
iolea5e e-:fi�c/l EU
s.�. .F
f� rr►�;f
C�,�;�P.,f �„�,$�� Jc,l�rrt �S {„� f /�,
�i. /'lt'Gs�y vie cry
`7P%�r°°�%�
�,�',,, Fes,
i<<•��o R�s:�F1�1 s�c�e%,ny, w����
017el 11"'ii
��lGTi7���
0,'/
r
1212VO4

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Noffiication O Other ❑ Denied Access
Date of Visit �� Time: �C
---- Facilir.v Number
..ro not Operational 0 Below Threshold
0 Permitted 01C�ertified ❑ Conditionally Certified
0 Registered Date Last Operated or Above Threshold -
Farm \amo- /T �'?fit �/i iidrs �.' rG:1 -,i! Cnnnt�• ���+7J1.�'4-f -
Owner Name: /4I��.�
i!r
7Pi a ly
_ Phone No: %/� `✓�p�
`r!j� >'
Mailing Address: — �-- �/ 2/
ii� r� /VC
Facilih Contact: Title:
Onsite Representative: Alk"i if (6701117X,
Certified Operator: Z"-!7
Location of Farm:
Phone No:
Integrator: &d4id le
Operator Certification Number:
&Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude l •�� �•
Design Current
Swine Iranneih Pnnnla"nn
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Ca acim Population Cattle Ca ackh, Population
❑ Laver I ELI
Dairy I
❑ Non -Laver Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I 1 I subsurface Drains Present J LJ Lagoon area ILI Spray Field Area
Holding Ponds / Solid Traps ❑ No Liq uid. Waste Management System
Discharges g Stream impacts
1 _ Is any discharge observed from any par[ of the operation?
❑ Yes W No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If dischars!: is obsen ed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is obsen•ed, did it reach XVater of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in ealimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? El Yes W No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [9 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WfNo
Structure I Structure ? Structure 3 Structure 4 Structure ; Structure 6
Identifier:
Freeboard (inches): u
05IV3101 Continued

Facility Number: YJ Date of Inspection I /''ETC
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
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
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes � No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
4. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Wastes Application
10.
Are there any buffers that need maintenance/improvement?
❑Yes
n7 No
11.
Is there evidence of over application? ElExcessive Ponding ❑ PAN ElHydraulic Overload
❑ Yes
No
12.
Crop type e gy_5 -14f. `r
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JONo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[0 No
b) Does the facility need a wettable acre determination?
❑ Yes
$4 No
c) This facility is pended for a wettable acre determination?
❑ Yes
W1 No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
(a No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
J4 No
14.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
5d No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W1 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes R1 No
23. Did ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes 4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ;9 No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ivo m n refer questtiin #� Explain aa`ny YESianswers a�it�d/or any recommendations or�any oche a° mi tints.
+'y- .'�A' ai7 - ' Ir 6 f ! �. - .5.,'.k �F -
Ilsedrawings of facihtyFto��better INNUons (nse addrtianal astnecessary)
explain pages r ❑Field Cony ❑Final Notes
Reviewer/Inspector Name
ReviewerAnspector Signature: Date:
05103101 r Continued

Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: 9
Gotr
a
Farm Name: t f _eK rI 4 Coantlr �„�
Ow= Na=: I QM 4 No.
On Site Representative: fIr • C� tcgrator: v r rc�-
Marling Address: L s
Physical Addtessd ocation• _ -EE ��20�_
Latittade �____ ,� ! Lon 'tuck• I_�..�1
Qperation Description: (based on design dtaraeterkdes)
ape itS _ No. of Anitna4 Type of Pou try No. of An&=4 Type of Cattle No. of Anima4
0 San 0 Lrya O Dairy
0 Nm=y v Non -Lays 0 Beef
0Feeder DtherType of is *Vun&cr of Aninuth: 1�9& �/ C.o
Ntunber of Lagoons: --(include in the Drawings and Observations the fiveboard of each lagoon)
Faafty nsnection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm s
Is seepage observed from then lagoon?:
Is erosion observed?: Is any discharge observed?
O Man-made O Not Manmade
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
(list the caps WAA need inWrom+mm)
CWPtype
�_
SetbWA CHtr & - ,
Is a dwelling located within 200 feet of waste application?
Is a weIl located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
'Is aniinal waste land applied or spray irrigated within 25 feet of BIue Line Stream?
A01— JannacT 1749%
Yes ❑
No
Yes 0
No
Yes ❑
No
Yes ❑
No
7
Y4jI3�No
Yeses.
No ❑
Yes C] -Nop,
.yes ❑ ,Noi&
0
es ❑ No CI
s

Ma�tc�aa�ae •
Does the facffity maintenance need mprovenient?
Yes D No
b there evidence of past discharge from any part of the operation?
Yes D No D
f Does record keeping nerd improvem oO
Yes D No D
Did the facility fail to have a copy of the Animal Waste Management Plan on she? Yes D No D
Explain any Yes answers-
Sigaania,e•
Dane: S to
cc-Fadliry Auesunm Unfit
Use .ittado ntt tfNee&d
-
]Qrawings or Qbservatians:
�u +ye�.r. F jvoder( .�- Nnd x l3 " of
'
aF,� ,k15
bkC� dear
e
G�e..T �(� v d.e� ,
l A
1) II ,-
_ dad AAY-C �X"C -SS-54-or'a� <<� +j,4 1p.von Sc)Sc7
oL
w i K4e— N— VAT
41
• ar �M: 'j.J '•:•/. - -. - - r w: w.+,rF.-+w�. �-•�., /..�� -. •Y• � •Mre•MQ•iN'<r•4Y'►.w.�+.. .Y—«��� �{--
' �* �� _• .� . • Ar.:/—�.. A/T^ ��_�•H
'1 •�r7 1 �: { .��. •iI{ M i � �.�IMM. � r•. ,.
AOI — January 17,19%

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Steve W. Tedder, Chairman
Allen Cannady
Allen Cannady Farm # 1
1730 Wright Bridge Rd
Clinton NC 28328
Dear Mr. Cannady:
KMAI
A/ ••
yr
D E N F111
RECEIVE,:u
. r.
FAYETT
ILE
REG. �jZ -
Subject: Classification of Animal Waste Management Systems
Facility: Allen Cannady Farm #1
Facility ID #: 82-698
County: Sampson
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on
Agricultural Waste, was enacted by the North Carolina General Assembly on June 21, 1996. This bill
requires that a certified operator be designated as the Operator in Charge (OIC) by January 1, 1997, for each
animal waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more
horses, 1,000 or more sheep, or 30,000 or more confined poultry with a liquid animal waste management
system. Our records indicate that your facility is registered with the Division of Water Quality and meets
the requirements for designating an OIC.
A training and certification program is available for animal waste management system operators. For
information on the training programs please contact your local Cooperative Extension Agent. Operator
certifications are issued by the Water Pollution Control Systems Operators Certification Commission
(WPCSOCC). For information on the certification process, please contact the Technical Assistance and
Certification Unit at [phone]. The type_of training and certification required for the operator of each
system is based on the nature of the wastes to be treated and the treatment process(es) primarily used to treat
the animal waste. There are two types of animal waste management systems, type A and type B. Type A
animal waste management systems are generally used to treat waste generated by monogastric animals
which produce a low -fiber waste. Type B animal waste management systems are generally used to treat
waste generated by ruminants and other animals which produce a high -fiber waste. The type of training and
certification an operator receives should correspond with the type of system(s) they intend to operate. For
more information on the classification of your system please contact the Technical Assistance and
Certification Unit.
-- As the owner of an animal operation with an animal waste management system, you must designate an
Operator in Charge and must submit the enclosed designation form to the WPCSOCC. If you do not
intend to operate your animal waste management system yourself, you must designate an employee or
engage a contract operator to be the Operator in Charge. The person designated as the Operator in Charge,
whether yourself or another person, must possess a currently valid certificate of the appropriate type.
Sincerely,
'N.�
Joseph B. McMinn, Supervisor
Technical Assistance and Certification Unit
cd/AW OIC Designation
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper