820246_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Quaff

C4-\�u5 11 �i ^c tR'. MD
g4
Type of Visit: aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 04outine 0 Complaint Q Follow-up O Referral O Emergency O Other I) Denied Access
Date of Visit: yj _5.ev; Arrival Time: Departure Time: County: Region: rr-O
Farm Name: _ L ct S i�Q�C� f �Gt Y�'�i Owner Email:
Owner Name: �. Q v� S E 2tj G.A Phone:
Mailing Address:
Physical Address:
Facilit
y Contact; testa-�,_IS � ct✓`Wt G(� Title:
Onsite Representative: _
Certified Operator: d a tLj tEN c1j dr "
Back-up Operator:
Location of Farm:
Phone:
Integrator: W&.s
Certification Number: Z_U J 2 0
Certification Number:
Latitude: Longitude:
Design Current
DFsiR--nlKGurrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pog.
Cackle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Z&CV ZZ-0
I
INon-LUer
I
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , l;onitr
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
- -
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream lmnact5
1. Is any discharge observed from any part of the operation?
❑ Yes
Q-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
D-15-A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑'9A
❑ 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
0 No
[3]<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�JNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[]'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - 2 Date of Inspection: a U
O blf=
Waste'Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q'1 Two
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
D-KA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[D l 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
[RN'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
0940
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑Xo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E]I�0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�Io
❑ NA
❑ NE
maintenance or improvement?
l I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑�To ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G' SU Q�
13. Soil Type(s): („ 1st j w
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ea.Xi ❑ NA ❑ NE
Does the receiving crop and/or land application site need improvement? 2-Y-es ❑ NA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E5 Flo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [D-go❑ NA ❑ NE
❑ Yes C3'No ❑ NA ❑ NE
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 []-ice ❑ 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 ❑-' ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C3-K-o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [: No [DNA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
jjry
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
R2 o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
4o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L^f 110
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes c[Ko ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �lo ❑ 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 [TNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes []'-No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes []'go ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E3'1�o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2'5o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
LAI e-'Fe-elde-f ';'A"-6f-
- f (y ��-� Co 4"
k�'��A'r'
��
C-f4 I (o - .3o �- t 8 5(
Reviewer/Inspector Name:
Phone)o'1133 _33 3
Reviewer/Inspector Signature:
Page 3 of 3
Date: b 'Tu --t. I g
21412015

lug, r i t
Facah Nu _ ivi'ston of Water Resources
ty tuber ® t(b ®Division of Soil and Water Conservation
- ® Other Agency
rype of Visit: Q-Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: eRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: U i P Arrival T, iime. 3� Departure Time: { s 5 lsJ} � Yq
Farm Name: Lu toe ' County:
� � p.r�^� Owner Email:
Owner Name: 1 '�rt r Phone:
Mailing Address:
Physical Address:
Region:.
Facility Contact: aJ t 5 cr We Title: Phone:
Onsite Representative: ! f Integrator: �1 S S
Certified Operator: ":L_L_dWCr s Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Des
Swine - Capacgtty
�"
'Pop,I'
i�Vet Poultry: Capagn�Current
u
ci#y Pop
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder Z&O
a tjoa
Non -Layer
Dairy Call
Feeder to Finish
Dairy Heifer
= De"sign Current
Farrow to Wean
Dry Cow
D`,'P,oultry Ca aci Po
Farrow to Feeder
Non -Dairy
Fj
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beer Feeder
Boars
Pullets
Beef Brood Cow
+t
Other
16
=
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a, Was the conveyance man-made?
b, Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�io- ❑ NA ❑ NE
❑ Yes
❑ No
[frNA
❑ NE
❑Yes
❑No
[DNA
ONE
[:]Yes
[—]No
❑'NA
ONE
❑Yes
[3Nio
[] NA
❑NE
❑ Yes
E] No
[] NA
0 NE
Pale I of 3 21412015 Continued

Facility Number: J;i. - (Q► Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ 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
EJ-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
�lo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�No
❑ NA
0 NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
13'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
[3No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 4.,-, S(�j —
13. Soil Type(s): L1f [L
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 [3r o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q'f,4o ❑ 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 ❑1Go ❑ NA ❑ NE
[:]Yes [ o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [D] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [J-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 El"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes &No
23. If selected. did the facility tail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes EfNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Nupaber: yb Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3<o
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check D- s ❑ No
the appropriate box(es) below.
allure 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 ®-10
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Erl4o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes .el ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
[:]yes
]o
❑ Yes [] Na
❑ Yes 21"No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
—f `, (1 v C is ,r w �x/'t' S i� 1'"t J Jays
ell 9'fo- .3o4 -t M
Reviewer/Inspector Name: ID Phone:-LU' m_ 3,j j y
Reviewer/inspector Signature: ►I Date: 5
Page 3 of 3 21412 15

1MS .30j jtv" I(c 137
QTDIvision of Water Resources
Facility Number - !J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: S� - Region:
Farm Name: �e� i �--v r�+�i_ P i`Owner Email:
Owner Name: I`, �� cQ ' AkL'.`d 5 Phone:
Mailing Address:
Physical Address: Q
Facility Contact: �Ctk A, " f - 9Q,s1-&J 644� Title: Phone:
Onsite Representative:
Certified Operator: 0tow ` J- E Ctto" f
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
0
Other
Other
Latitude:
Integrator: Y vk 15 __s
Certification Number: Z7 2-Q
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer I I :::::]
Non -La er
Design Current
Non-L
Pullets
Other
Poults
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0 Yes ❑,No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes �To ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes �o ❑ NA ❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
0
Page 1 of 3 21412015 Continued

Facility Number: W_ - ,-Lt t, I I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g3'1qo_ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Io ❑ NA ❑ NE
Structure l 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
Q ""'
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[E'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]' oo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-ITo'-
❑ 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
C3" Wo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�..�
II No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0-Vro'-
❑ 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 3, G V
! /
13. Soil Type(s): W Ok_ ( t14
14. Do the receiving crops differ from those designat d in the CAWMP?
❑ Yes
[30'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
[3'-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E!rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[jj"NNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
El"No
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[-]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
�
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
o
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[ No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R-5551 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [alqb_ ❑ 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 EJ Ro ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IJ '"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Q►L'd"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?
[D Yes
E]-N—oo
❑ 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
[ -'Nb
❑ 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
Q 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]r&o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[fNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C:fNo
❑ NA ❑ NE
Comments (refer:to question #f): Explain any YES answer's and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c"Uxtl 4^L,".1
Reviewer/Inspector Name:
C, N I _ po'
Phone: - � . ) 5"
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Date of Visit: / Arrival Time: .JO Departure Time: ► County: • Region:
Farm Name: �� �y F�rr•� Owner Email:
Owner Name: �GtUr� s�u/Qv� Phone:
Mailing Address:
Physical Address:
Facility Contact: zMVp/'e— Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Integrator: /yf/
Certification Number: D
Certification Number:
Location of Farm: Latitude: Longitude:
:: Design, Current
Desiign-
Currentl
urrent
Swore •; _ Capacity Pop.
Wet Poultry
Capacity.
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
o
Non -Layer
airy Calf
Feeder to Finish
Design
Current
airy Heifer
D Cow
"
Farrow to Wean
Dr. Foul
Ca aci
Po
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
wipttv
Turkc s
s�Other
Turke Poults
Other
Other
DischarPes and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes [a -No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes []No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes ®-No
[:]Yes C3-.No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: Date of Inspection:
. Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): }' i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C!.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 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
[RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®. No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[!�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5�,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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). �'�-��{��Z 941 n2 �_�
13. Soil Type(s): j,U era.,,_ / ^
14. Do the receiving crops differ from those designated in the CAWMP?
[]Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(N-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J!�-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
❑ 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
[D No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection:
= 24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C3-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2& 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/Irispector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
O-No
❑ NA
❑ NE
❑ Yes
D—No
❑ NA
❑ NE
[:]Yes
[allo
❑ NA
❑ NE
❑ Yes [2FNo ❑ NA ❑ NE
❑ Yes J&No ❑ NA ❑ NE
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes 1 No
❑ Yes EE�No
[:]Yes gNo
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Comments (refer to question. #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use'additional pages as necessary).
Reviewer/inspector Name:
Reviewer/inspector Signature:
Phone: 1 5 vo
Date: /% l
21412014
Page 3 of 3

Ste-
" ivision of Water Quality
Fac�,Nj- ( Division of Soil and Water Conservation
0 Other Agency
I N
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0"Iloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p ; D a Departure Time: County: Region: �=X
Farm Name: Lg -'� ; �d i,ti.`� Owner Email:
Owner Name: , DA J . t1 to „�S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 7:]b-e_j S,�,PC . Phone:
Onsite Representative:_ Integrator:
Certified Operator: ,�',� � �4�s Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
jDairy Cow
Wean to Feeder
Ao oD
D
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
sign Current De
D . foul Ca aciP.o P.
Layers
Non -Layers
Pullets I
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
I
I Beef Feeder
Beef Brood Cow
Boars
OtherI
Other
Turkeys
Turkey Poults
Other
Disehmes 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-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No
[:]Yes Ea No
[:]Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
[:3 NA ONE
Page 1 of 3 21412011 Continued

_ Facility Number: - Date of Inspection: p— r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
J;�LNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
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
�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
❑c ,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
EK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop/ Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r(l ✓'ht aela ZA rs X:r'4rrf
13. Soil Type(s): U L', ra", /,/`f-k.�'V1/►
14. Do the receiving crops difYr from those designated in the CAWMP?
❑ Yes
®.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
4R No
E. NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q4 No
❑ NA
❑ NE
1 S_ Is there a lack of properly operating waste application equipment?
❑ Yes
FNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
JNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Desibm [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: p-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [5f No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes SNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EELNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ED No [DNA ❑ NE
❑ Yes © No ❑ NA ❑ NE
❑Yes KNo ❑NA ❑NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
[:]Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Fi l• rn O v rr�� Sg i r: iz-tG cJ n1� rr
ReviewerlInspector Name:
Phone: �Iqfp-lZ_D_ .2-OV
Reviewer/Inspector Signature: Date: /p — /a
Page 3 of 3 21412011

Type of Visit: 0��'pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: udne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: s ! / Arrival Time: ® Departure Time: I Z I I County j Region:
Farm Name'er-e: �0 P Owner Email:
Owner Name: ,� �Gcy + C� .s�/�,orj Phone:
Mailing Address:
Physical Address:
Facility Contact: �• z-Y� /yj�dj� Title:
Phone:
Onsite Representative: �— - Integrator:
.01
Certified Operator: f>zz"iJ �.�/l,[/v.� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
D s gnu Curry a DesignCu rent Design C«urrent
p � �,
Swtne� Capacity Pvp ij Wet PoultryCapactty ;Pop. Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder INon-Layer_A I airy Calf
Feeder to Finish, _ sr, Dairy Heifer
Farrow to Wean VQesign-,jCurren Dry Cow
Farrow to Feeder D . P■oui Ca ace Pia , Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other �� Turkey Poults
Other 10ther
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 M-No ❑ NA ❑ NE
❑ Yes [:)No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes �o
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
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
R�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
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
Z,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
WOM"
❑ 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
[ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
B No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 2�q"/nc,;06
13. Soil Type(s): �jr y v� //� / `f/%
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[",No
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZLNo
❑ 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
2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Callo
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
'123
;..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. 54Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard JDHaste 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? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

. Facili Number: - Date of Ins ection: —/�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cff No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes M No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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
�jNo
❑ NA .
❑ NE
❑ Yes
FM No
❑ NA
❑ NE
❑ Yes
& No
❑ NA
❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
[—]Yes QO No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #r): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional naees as necessarv).
currYAJ Wa�k A117dlys
�-� �15 �a� W,�s7��
7 �h�,a/ 7A- 4z"07-3
�ZP. b /ovr- /,j 0-t G_ J 1)D.
yf 'r E' t- la
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9�O 1(13-33L
Date: _1 /j
21412011

type of V [sit.. LjLomplldllCe 111bPectlon v j Vperauon mevlew LJ afft[VtUre C.ValUaROn LJ i ecnmCal ASSIStanCe
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / ! Arrival Time: ; w Departure Time: c'7 County: L4!x,5A_—
Farm Name: Owner Email:
Owner Name:1L; p� �' ��yJa,r_ Phone:
Mailing Address:
Physical Address:
Facility Contact: 61-r7 - twmny— Title: T� zr-U. Phone:
Onsite Representative: —'—e_—
Certified Operator: Llr d S ��itlards
Integrator:
Region:
Certification Number: z' {�Q.a
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
F
Design�Cu�rent
DeslgnCurreat
Design Ctlrreut
Swine rCapactty Pop`'µ
Wet PoultryCapacttvPop.+,
Cattle Capacity Pop.
Layer
Dairy Cow
Wean to Finish
Wean to Feeder
& (b
1,91y p
Non -La er
D . P.o_ul
I Layers
Non -La ers
I
Design�Current
Ca aciPo ".
airy Calf
airy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
LHBoars
Pullets
113eef Brood Cow
s� r
Turke s
Utlter
�
TurkeyPoults
Other
Other
Discharges and _Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a" Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes 0 No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes ❑ No [DNA ❑ NE
[:]Yes [:]No
[]Yes 29 No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Jallo
❑ NA
❑ NE
a. If yes. is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in). -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z 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 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E,No
❑ NA
❑ NE
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
0 No
❑ NA
❑ NE
maintenance or improvement`?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L&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): ��I'ji'lNDfa �flU��vlCrdt-
13. Soil Type(s): �u�/`2 zzide ZG�a,�1�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[M-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
IS
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
51.Vo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment'?
❑ Yes
P_No
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
14No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
IS 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.
JQ Yes
o'_
❑ NA
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste AnalysisIVC3,Soil Analysis
❑ Waste Transfers
[] Weather
Code
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" 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: - Date of Inspection:
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document []Yes allo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
(&No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
El 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
ELNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessar_y).
T�;d Nzf, -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
21412011
Page 3 of 3

Date of Visit: 11 Arrival Time: -3'D 1 Departure Time: County:, Region: ztkz
Farm Name: , � ; W',-- Owner Email:
LOwner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �,rx-ter /jjgpy - Title: z
Integrator:
Certification Num o`ro
Onsite Representative: ss-,
Certified Operator: 00t� ",lrn�
Phone:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
...
., ? � Design
_ Des b Design Current
Current gCU rent.-
Swine `Capacity
-
Pop . Wet Poultry Capac�tyl'iap Cattle Capacity Pop.
-
- _Y �,._
Wean to Finish
Layer I I Dairy Cow
Wean to Feeder
119400 _ Non -La er I DairyCalf
Feeder to Finish
Farrow to Wean
Dai Heifer
Design�Current D Cow
Farrow to Feeder
u - ad aci P,o Non -Dairy
�oul
Farrow to Finish
Layers Beef Stocker
Gilts
`_
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Boars
-
x =.. .:..
Turkeys
"
Other _
f A
TurkeL Points
Other ~ _`
¢rt
._..
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 EANo [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes ER -No
❑ Yes 54 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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 ®..No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA [] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): _ 9
Observed Freeboard (in): 3�-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 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 E3 No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes tj� 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 10 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑Yes [ffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ E/vidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): / u.c, �i�s�'�� eS / ---
13. Soil Type(s): /,(/,z P,�� /j-A/Tr y Ui
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
1a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5�L 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
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r7 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C3-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [2�No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes DjNo ❑ NA ❑ NE
[:]Yes allo ❑ NA ❑ NE
❑ Yes M No
❑ Yes KNo
❑ Yes allo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). .,./
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: &9- 3 _3 0-V
I
Date: /1l—/,����/�
21412011

Type of Visit Cm Hance 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: Arrival Time: Departure Time: 0 71 q—S-1 County: Region: 11,k-Q
Farm Name: 1--a 7— cxane-r- Pi "j- ) Owner Email:
Owner Name: �,,ui5 _ Phone:
Mailing Address:
Physical Address:
Facility Contact:%at ir'br Title: ���lcPf� Phone No:
Onsite Representative: rr°�r�r�-✓ fkt4&FC- Integrator:
Certified Operator: �n+�%� .��u/af�s Operator Certification Number:g_ ,
Back-up Operator: & Back-up Certification Number: TM22,3
Location of Farm: Latitude: e Longitude:
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry _ .Capacityy opulatioo Cattle: - Capacity Population
El Wean ❑ La er ❑Dai Cow
❑Non -La er ❑Dai Calf
❑ DairyHeifer
x ❑ D Cow
Dty Poultry
❑
El Layers
❑ Beef Stocker
ElNon-Layers
❑ Beef Feeder
El Pullets
❑ Beef Brood Co
-
Liurke s T
Other ❑ TurkeyPoults
❑ Other ❑OtherNumber
- of 5truetures:
to Finish
Wean to Feeder
]7
D4?
El Feeder to Finish
El Farrow to Wean
Discharges &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?
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 ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 5& No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RLNo
❑ NA
❑ NE
❑ Yes
QNo
❑ NA
❑ NE
Page 1 of 3 12/18/04 Continued

Facility Dumber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
a No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[3 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
R9 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(9No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
U.No
❑ NA
❑ NE
maintenance/improvement?
11,
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12.
Crop type(s) /�r.�r�slit✓ /9 ciZnr rrIe �I
13.
Soil type(s) ryV : ye_ I/
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Od No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[SNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
R No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
[D No
❑ NA ❑ NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
KNo
❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Dame Y f Phone:
Reviewer/Inspector Signature: Date: /12
Page 2 of 3 1Zi.40ivy %-Untsnuru

PIr
Facility Number: —,4Z Date of Inspection Eb lam—! )
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[SNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[BNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ 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
CkNo
❑ 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
NJNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ff�No
❑ NA
❑ NE
Comments and/or
''y
12128104

0,7 -Z490 y AOIZ
Type of Visit Q);7__Op�u"tlne
C-nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dale of Visit: Arrival'Fime: 2; Y6 0.1 Departure Time: Ir%0 County: SG . 11^_/ Region:
Form Name: C� "'~ Owner Email:
Owner Namc: �oL�.l4 ✓ Phone:
Tailing Address:
iJ
Physical Address:
Facility Coninct: 6 6'e- c le- AAOJ r L Title: � � :a C— Phone No:
Onsite Representalive: C� ►'e c- ►� %L(CT� �� Integrator-. M- gpo'J"i
Certified Operator: Z>au [CL Operator Certifies I io n Number: 2 0020
Hark -up Operator: Bark -up Certification Number:
Location of Farm: Latitude: =O ❑ ' ❑u Longitude: ❑o = I = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
2 bD Ari ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNan-La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
El Dal Heifei
El Dry Cow
El Non -Dairy
❑ Beef Stocker
ElBeef Feeder
❑ Beef Brood Cowi
Number of Structures: UJ
b. Did the discharge reach waters of the State? (if yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? Of yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ' ' o ❑ NA ❑ NE
❑ Yes
❑ No
L1 NA
❑ NE
❑ Yes
❑ No
PIA
❑ NE
ETNA
❑ NE
❑ Yes
❑l, No
El Yes
EKc
❑NA
❑NE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 8 — Date of Inspection
Waste Collection & Treatment //
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes BNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Z No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -I(/- /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z �f J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ L� 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 El Yes LI 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? El Yes ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNNo ❑ 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 EJ No ❑ NA [:3 NE
maintenance/improvement? /
]I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L3wjl' Jlk_ 06yj f S;"c60,---
13. Soil type(s) A-c a4E
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MlVo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
B o
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination Yes
E%❑ NNo
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElE Yes
ET -No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
a o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES'answers.andlor any recommendations or any other comments.
Use drawings.Of facilitg to`better explain situations. (use additional.pages as necessary): ,
Reviewer/Inspector Name k Kfr R,r✓c S T- --T-_ Phone: j,/O, ju_:r 33Q 0
Reviewer/Inspector Signature: Date: /z-07-200 9
12128104 Continued

Facility Number: 92 —ZSf(p Date of Inspection
Repaired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes bNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n 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
❑ Rain€all ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ON.
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[5 NNo
[INA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,L,3�<o
[3 N"o
[I NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[R o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,BIND
BNo
❑ 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
LNo
"f
ET*
❑ 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
C7 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
�,
LI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LI No
❑ NA
❑ NE
12128104

✓ grAs 1-08 -- 0 9 lee_
%"tvt�ision.of Water Quality
Facility Number z Z O Division of Soil and Water Conservation
Q Other Ageney
Type of Visit (r o'mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 011o'utine O complaint O Foilow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: VZ-OV-4941 Arrival Time: %O; Departure Time: /O.' r County: j4P!! Ja✓ Region:40
Farm Name: ela/1/I N id ia 4. -d S 1-Zan!q Owner Email:
Owner Name: bA s d 6�A-t..jaycl s Phone:
Mailing Address:
Physical Address:
Facility Contact: �rt c i� /�D %"C,.� Title: �GG - Phone No:
� Bra,,✓ ✓
Onsite Representative: �s �-�� N[vo r'� Integrator: l� �'�
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: [_—]o =]' [_—] Longitude: [�o =, = «
Z(p p
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -Layer
❑ Wean to Finish
Wean to Feeder
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
ElPullets
❑ Turkeys
El Turkey Poults
ElOther
Discharges & Stream Impacts
1 _ is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood CovA
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?
Page I of 3
❑ Yes 0'56 ❑ NA ❑ NE
El Yes
Discharges & Stream Impacts
1 _ is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef Feeder
❑ Beef Brood CovA
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?
Page I of 3
❑ Yes 0'56 ❑ NA ❑ NE
El Yes
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?
Page I of 3
❑ Yes 0'56 ❑ NA ❑ NE
El Yes
❑No
3'VA
El NE
❑ Yes
❑ No
OI A
❑ NE
[3'7gA
❑ NE
❑ Yes
❑ No
❑ Yes
[4�o
❑ NA
❑ NE
❑ Yes
27'0
❑ NA
❑ NE
12128104 Continued

Facility Number: Z-Z
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: -d—/
Spillway?: A10
Designed Freeboard (in): /q
Observed Freeboard (in): a�
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 Ej No ❑ NA ❑ NE
❑ Yes B' o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 9-No ❑ NA ❑ NE
❑ Yes [TNo ❑ 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 31_q7o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3'�fo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 9�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes BITo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9-no- ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) ge_t—m�^ f'f614 .) . 4r-A:, /'D. S.)
13. Soil type(s) fttA LjA-B
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 Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[]TVo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
0'176
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[}lam
❑ NA
❑ NE
Comments (refer to q span #): Explhin�atiy YES answers and/or any recommendations or any other comments.
Use drawings of facifity3tobetter explain situations. {yse additional pages as necessary):
Reviewer/Ins `` G,,J"'
ector Name Phone: q/O S`33.333n
p I" jG�, e.4s
.E
Reviewer/Inspector Signature: Date: /Z —O y— ZaDB
Page 2 of 3 12128104 Continued

Facility Number: S2 —Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑<o ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElE Yes c, ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists g p El Other
❑ Design ❑ Maps
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes a% ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑'Ao ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Eallo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ElNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
DNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
aiqo-
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Bl�_o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fo
❑ 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
❑'qo-
❑ 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
[r 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
D-55
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Q7o—❑
NA
❑ NE
AdditioalfCommetits Mndl_o D awin s:.� yr.
....g L
H
Page 3 of 3 12128104

B�/LJS Z / 91 z 00
® Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: Region: FQd
Farm Name: CCd Jf Aj CA is yA5 Fgjc,,vt Owner Email:
Owner Name: CCJ U fN 1�4..a Z eC_ Phone:
Mailing Address:
Physical Address:
Facility Contact: G' YL a�►'L Title: I czt_ . 5l>e-c Phone No:
Onsite Representative: 6; r<r�, Akovre_ Integrator: riA UVD & ., - R v-DL lnl
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o [ = = it Longitude: ❑ ° E__ =
Design Current Design Current
Capacity 'Population WetPoultry Capacity Population
❑ La er
Zboo 12 70 ❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge ori-inated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures: M
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes W No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
P9 No
❑ NA
❑ NE
❑ NA
❑ NE
El Yes
[pi No
❑ Yes
(A No
❑ NA
❑ NE
❑ Yes
[U No
❑ NA
❑ NE
12128104 Continued

' Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stoma storage plus heavy rainfall) less than adequate'?
❑ Yes
UjNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[gNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
�No
El NA
[I NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[Z] No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[I No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Eff4"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[IrNo
❑ NA
❑ NE
maintenance/improvement?
11.
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
O'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) Gir►a�w a� *� �rMS f'� �irn: n► (Q r1CrSC� /
13.
Soil type(s) B
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
P No
❑ NA ❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Yes
[P No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[21No
❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerlinspector Name tC P�t.(S Phone: %!O, V33, 3330
Reviewer/Inspector Signature: t..� Date: /z - /O -- Z o a 7
IciZoivv Uunflnueu

Facility Number: aZ Date of Inspection -10-07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [11 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[!4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[)I No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[XNo
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M 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
PO 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
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

x
Division of Water Quality
+Facility Number gZ Z q, 0 Divisian;ofiS.oil and Water Conservation
Agency
Type of Visit ® Compliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine Q Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %/,Z$ 0 Arrival Time: //; D Departure Time: %Z,` County:
Farm Name: _ Q.1tlr A/ Gr..J��C / i-1..� Owner Email:
Owner Name: C_a./i/i11W 4 "IU-Q" Phone:
Mailing Address:
Physical Address:
Region- `XO
Facility Contact: ,3 re t. ✓' M o-p✓'-e Title: ,e-r Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1--] 0 0 I ❑ 11
Longitude: = o = I =
11
"'L`lmfdY_
Design Current Design, �� " Current
Design Current
Swine
Capacity "rapul Wet oult cc, apacityi'opMarion
Cattle Capacity Population
❑ can to Finish
❑ Layer
❑ DaiEy Cow
can to Feeder
ZQ ❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
gd
❑ Dairy Heifer
❑ Farrow to Wean"y
;Dry�P�anitry
❑ D Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
� Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
❑ Turkeys
Otlter
L r� El Tur key Poults
❑ Other
❑ Other
Numbe�'ofaStrcictures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[2jNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[A No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
❑ Yes
[WNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[,7No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Q?No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

. I
• Facility Number: — Z IV6 Date of Inspection !! Z p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[M No
❑ NA
❑ NE
through a waste management or closure plan`?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� 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)
i'
9. Does any part of the waste management system other than the waste structures require
[--]Yes
N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [A No ❑ NA ❑ NE
maintenance/improvement'?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [YNo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 ❑ ApplicationOutsideof Area
12. Crop type(s) Re,VjU u d GL 7`> c.. S r�G/C?►'t?i..� LDS . J
13. Soil type(s)� rj(JdlJ
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Lp No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[,51No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5d No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1
r
Reviewer/Inspector Name +�� Reel¢. $ Phone: - S
Reviewer/Inspector Signature: Date: <o
Page 2 of 3 I2/28/04 Continued

Facility Number: Z -Z Date of inspection
Required Records & Documents
19. Did the facility fail to have 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 El Design El Maps El Other
❑ Yes
,{] No
❑ NA
❑ NE
[I Yes
�No
El NA
❑NE
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
if yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
Q1 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
W NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
ER NE
❑ Yes
[%No
❑ NA
❑ NE
El Yes
El No
❑NA
[0NE
❑ Yes
(� No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[�j No
❑ NA
❑ NE
Page 3 of 3 12128104

e
CFart�tty.Number
g j
® Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 09 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: li 9 Arrival Time:
Tii/me: j D 3p Departure Time: County: 104 Region: _005eO _
Farm Name: CrrLgr,A foe", Owner Email:
Owner Name: Cc ,jti� _G��a�s D Phone:
Mailing Address: P 0. do_2c �!7.2 /l_QsBLs�ro NG ��-3
Physical Address:
Facility Contact: CLee,- Afaaet
Onsite Representative: G.-rcr,
Certified Operator: Ca.Li� _� ��wa►r��
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:t.��%" 'QG� •�
Operator Certification Number: Z2a,CP,1,9
Back-up Certification Number:
Latitude: [�J o = ' = « Longitude: ❑ o = ,
Design Current . Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
pp ❑ Non-Layet
❑ Wean to Finish
Oj4ean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turk -ex Pou Its
❑ Other
Discharges & Stream Impacts
_ Is any discharge observed Isom any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State`' (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does dischar�ze bypass the waste management system'? (If yes, notify DkN'Q)
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 [91<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
❑No
❑ Yes
El o
❑ NA
❑ NE
❑ Yes
2 o
❑ NA
❑ NE
i
12128104 Continued

Facility Number:1,-7 --2y{p
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
j Identifier:
Spillway?: -10
Designed Freeboard (in):H Al
Observed Freeboard (in): 2,4y e'
Structure 4
❑ Yes D<o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA - ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[9'1Qo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[4-<o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
D<oo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
U-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
[a qo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EK
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
so
12. Crop type(s) O,rerseer�( „B r .21 iz ch c ea s s
13. Soil type(s) rc.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 3<o ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes Ao ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes ❑ No ❑ NA EIKE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA DNE
❑ Yes [2'10 ❑ NA ❑ NE
Comments (refer to question #)' ,Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facHity to better explain situations: (use additional page's as necessary):
Re�:ewel/ ales.
Ae- ove�s�sei ja51- parr., ev'f. Akese !'eme,.�
Reviewer/Inspector Name %�a�/C &prifMr Phone: 4f0--tr L /Iy/ erf%fD
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 8> —3y& Date of Inspection
Required Records & Documents �/'
f 9. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes [?- o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
L3TNo
❑ NA
❑ NE
the appropirate box. ❑ ��r ❑ Ch tsts ❑ D gn ❑s ❑QLhrsr
21.
Does record keeping need improvement? If yes, check the appropriate box bel W.
❑ Yes
❑ No
❑ NA
❑ NE
❑ [:1 W-=�eboard ❑ ransfers
[jAR
m n
❑ iait`ii 5 ❑ $trn-]cirsg ❑ Crop Yield ❑ s ❑
ion,_s❑
�ed�
22.
Did the facility fail to install and maintain a rain gauge?
El yes
,,
OK
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
e<E
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
❑ No
❑ NA
E31ME
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;H<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
U<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
D-KE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes Ia 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
[ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
Q�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional eomme'n s•an&or Drawins: '
"ee1-601 C1',p �itld �o/`wtis
12128104

of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit 4b Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
.�.,,,.� 0 Not rational 0 Below Threshold
Ellermitted Et ertified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ......... .. ..
Farm Name: ........... ....... Gs: �i%�1 ---`' '� — County:.... Sub Sort ............................. .. �%�D...... ... _
.. Phone No: ..... - a. Z ............
Owner Name: �G/v:"�............L�s:�:�rrc%�................ --.....----••-w-/-•--------- /U- ..... ............
Mailing Address: � U, 16oX �772 .t1.?.s !;.4.... NC ................. f 3 ................. ..........................
Facility Contact- v, L-dac ard� .. Title: ............... Phone No:
Onsite Representative:.._.............�.. ........................--. Int tor•
_------•----•--. e� ....ilk.��---- -------
-�--•.......__..�...�_.�.�.__..�
Certified Operator... 'A" ...... _.... ................ Operator Certification Number:
Location of Farm:
E}3'w'ine ❑ poultry ❑ Cattle ❑ Horse Latitude • ` 4�4 Longitude • 4 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes E -w
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d- Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ONo-
❑ Yes 0-Mo -
❑ Yes ❑wo--
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other titan from a discharge? ❑ Yes 0 Nt�1
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes E}Nfl
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ ---1....... ............ _..........................
Freeboard (inches):
12112103 Continued

Facility Number: 9 - , y (p
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes ❑N-0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑Yes O
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 2'1qo-
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes Q-N6
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
[}-No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�0
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
0-N6'
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 17ermysl'.L 5/h4 1Z G rC ir+ riay
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ETT4-o—
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
O-No
c) This facility is pended for a wettable acre determination?
❑ Yes
®-Nb
15. Does the receiving crop need improvement?
9-Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[g+io
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes E -No
19. Is there any evidence of wind drift daring land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 3 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes []-No
Air Quality representative immediately.
Couunents (refer to q� n #)� Faplazn airy YES:answers and%r auy_wecomations any other copamenEs.
Use d awtuAgs of fanlrty to l etteT eacplam sttoat addrhonial pages * necessary? [g-Field COPY ❑ Final Notes t
!Z
AL
/S 7P✓P�'ci' LvPGI� S�o/5 O� Cp[r��G�� ! n fhG 5�, n� J ro��', /P41-5
Oht i f 0 r V S.�t)r7 1 i�d r � � /!o TO � S�tr b ��.f h d
Irv- 3�v--7qy 5 �r,�tr
�
s/' y for weds aS i1 rr<�E
Reviewer/Inspector Name
Reviewer/Inspector Signature ft" l / 5 f Date:
12112103 Continued

Facility Number: 91A _� y Date of .Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
O-Ne-
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ , c eckti u,.desig`n, , etc.)
❑ Yes
23_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ No
❑ Waste Application Fr�bumrd ❑ ❑ Soil Sampling
p
� with
24. Is facilitynot in c liance an applicable setback criteria in effect at the time of design?
P Y �P g
❑ Yes
Q No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
C-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[moo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O-No
28. Does facility require a follow-up visit by same agency?
❑ Yes
O-No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[}No'
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
PN6--
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Site Requires Immediate Attention: Np
Facility No. $Z - 2 4 (c
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Au z , 1995
or
Time: / Z S 3 3
Farm Name/Owner: Ecl ward 5 /IlccrSc r y COLT ViAl ,E_ ujardS
Mailing Address: o-,C IV72_ z 9,3 Sa .�
County:- aM S-Pwj
integrator: Q.K: .-.k s Phone:
On Site Representative-:' Cal v N Gd �,,,a ►.�%s _ Phone: 1"9/7J 57- S - 53 7& 5375_
,Physical Address/Location: SR 1 z 47
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 2, coo N� � Number of Animals on Site: -2. Goa -- - .
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: a '
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes r No Actual Freeboard: � Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or RDWas any erosion observed? Yes or40
Is adequate land available for spray? r No Is the cover crop adequate? (& or No
Crop(s) being utilized: Row C" s W i m
R e.
Does the facility meet SCS minimum setback criteria?
200 Feet from Dwellin s?
100 Feet from Wells? YY
Yes or No
or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(!p
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ox&�
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(o if Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (& or No
Additional Comments:
Inspector Name
Rom, Re"�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.