820254_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai

I_
E Oivisian of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number: 820254 Facility Status: Active
Permit: AWS820254
Denied Access
Inpsection Type: Compliance Inspection
Inactive Or Closed Date:
Reason for Visit: Routine County:
Sampson Region:
Fayetteville
Date of Visit: 03/22/2017 Entry Time: 09:30 am Exit Time: 10:00 am Incident #
Farm Name: Bearskin Nurseries
Owner Email:
[e-mail]
Owner: Goshen Ridge Farms LLC
Phone:
910-592-3392
Mailing Address: 905 Coharie Dr
Clinton NC 28328
Physical Address: 1421 Concord School Rd
Clinton NC 28328
Facility Status: Compliant ❑ Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm: Latitude:
34° 59' 11" Longitude:
78° 26' 42"
Hwy. 24 from Clinton at Concord cross roads take right - 4 miles down on left.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator:
Robert T Young
Operator Certification Number: 19461
Secondary OIC(s):
OnSlte Representative(s):
Name
Title Phone
24 hour contact name
Mike Ammons
Phone
On -site representative
Mike Ammons
Phone
Primary Inspector:
Robert Marble
Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number. 820254
Inspection Date: 03/22/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Wean to Feeder 10,400
Total Design Capacity: 10,400
Total SSLW: 312,000
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
24.00
37.00
Lagoon
2
24.00
41.00
Lagoon
3
24.00
47.00
page: 2

Permit: AWS820254 Owner - Facility: Goshen Ridge Farms L Facility Number. 820254
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Y
No Na No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
EIN
❑
b. Did 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)
❑
❑ M
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
N ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yea
No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑0
❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11, Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

ly
Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Ha No
Crop Type 1
coastal Bermuda Grass
(Pasture)
Crop Type 2
Fescue (Pasture)
Crop Type 3
Small Grain Overseed
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy sand, 0 to 2%
slopes
Soil Type 2
Wagram loamy sand, 0 to
6°% slopes
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
M ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820254 Owner - Facility: Goshen Ridge Farms L Facility Number. 820254
Inspection Date: 03/22/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na Ne
• Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
M ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
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?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes No No No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ ❑ ❑
CAWM P?
33. Did the Reviewedlnspector fail to discuss reviewrrnspection with on -site representative? ❑M ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ 0 ❑ ❑
page: 5

r
Facility Number: 820254
Division of Water Resources
Division of Soil and Water Conservation
Other Agency
Facility Status:
Active Permit: AWS820254 11Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine County:
Sampson Region:
Fayetteville
Date of Visit:
09/22/2015 Entry Time: 02:00 pm Exit Time: 3:00 pm Incident #
Farm Name:
Bearskin Nurseries
Owner Email:
[e-mail]
Owner:
Goshen Ridge Farms LLC
Phone:
910-592-3392
Mailing Address:
905 Coharie Dr
Clinton NC 28328
Physical Address:
1421 Concord School Rd
Clinton NC 28328
Facility Status:
Compliant El Not Compliant Integrator:
Murphy -Brown LLC
Location of Farm:
Latitude:
34' 59' 11 Longitude:
78' 26' 42"
Hwy. 24 from Clinton
at Concord cross roads take right - 4 miles down on left.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other issues
Certified Operator: Robert T Young Operator Certification Number: 18461
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone
On -site representative Mike Ammons Phone
Primary Inspector: Robert Marble Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 09/22/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Wean to Feeder 10,400
Total Design Capacity: 10,400
Total SSLW: 312,000
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
24.00
50,00
Lagoon
2
24.00
65.00
Lagoon
3
24.00
42.00
page: 2

Permit: AM820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 09/22/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na Ne
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Applic.ation Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
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)
❑
M ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes No Na_ No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.eJ large
❑
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na Ne
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 09/22/15 1npsection Type: Compliance Inspection Reason for Visit: Routine
Waste Aaplication
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Fescue (Pasture)
Crop Type 3
Small Grain Overseed
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy sand, 0 to 2%
slopes
Soil Type 2
Wagram loamy sand, 0 to
6% slopes
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ M ❑ ❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ M ❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑M ❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ M ❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑ ❑ ❑
Records and Documents
Yes No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ ■ ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ M ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
[]
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820254 Owner -Facility: Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 09122f15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Rainfall?
n
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑ []
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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?
❑
M ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ ❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with on -site representative?
[]
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

W
■ Division of Water Resources
❑
Division of Soil and Water Conservation
Other Agency
Facility Number:
820254 Facility Status: Active
Inpsection Type:
, Compliance Inspection
Reason for Visit:
Routine County:
Date of Visit:
08/19/2014 Entry Time: 01:30 pm Exit Time: 2:3
Faun Name:
Bearskin Nurseries
Owner:
Goshen Ridge Farms LLC
Mailing Address:
905 Coharie Dr
Permit: AWS820254
Denied Access
Inactive Or Closed Date:
Sampson Region:
Fayetteville
m Incident #
Owner Email:
[e-mail]
Phone:
910-592-3392
Clinton NC 28328
Physical Address: 1421 Concord School Rd Clinton NC 28328
Facility Status: ■ C i- El Murphy -Brown LLC
amp pant Not Compliant Integrator.
Location of Farm: Latitude: 3459' 11"
Hwy, 24 from Clinton at Concord cross roads take right - 4 miles down on left.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Waste Col, Star, & Treat
Other issues
Longitude: 78" 26' 42"
■ Waste Application
Certified Operator: V'Alliam Victor Sutton Operator Certification Number: 26076
Secondary OIC(s):
On -Site Representative(s):
Name Title Phone
24 hour contact name
Mike Ammons Phone:
On -site representative
Mike Ammons Phone:
Primary Inspector:
Robert Marble Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
page: t

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 08/19/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
[� Swine - Wean to Feeder
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
24.00
Lagoon
2
24.00
Lagoon
3
24.00
page: 2

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 08/19/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No Na No,
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
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?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0110
State other than from a discharge?
Waste Collection Storage & Treatment
Yes No Na No
4. Is storage capacity less than adequate?
❑
0 ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
MEJ
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
s ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
M ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
■ ❑
❑
maintenance or improvement?
Waste Applicabon
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

t
Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 08/19/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes No Na No
Crop Type 1
Coastal Bermuda Grass
(Pasture)
Crop Type 2
Fescue (Pasture)
Crop Type 3
Small Grain Overseed
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk loamy sand, 0 to 2%
slopes
Soil Type 2
Wagram loamy sand, 0 to
6% slopes
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ 0 ❑ ❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ 0 ❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ E ❑ ❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ 0 ❑ ❑
1 B. Is there a lack of properly operating waste application equipment?
❑ 0 ❑ ❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
if Other, please specify
21. Does record keeping need improvement?
❑
0 ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
page: 4

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 08/19/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No,
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a PDA 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?
❑
E ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
[]
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 5

Division of Water Resources
Division of Soil and Water Conservation
Other Agency
Facility Number:
820254 Facility Status: Active Permit:
AWS820254
❑ Denied Access
Inpsection Type:
Compliance Inspection
Inactive Or
Closed Date:
Reason for visit:
Routine
County: Sampson
Region:
Fayetteville
Date of Visit:
10/17/2013 Entry Time:
02:00 pm Exit Time: 3:00 pm
Incident #
Farm Name:
Bearskin Nurseries
owner Email:
[e-mail]
Owner:
Goshen Ridge Farms LLC
Phone:
910-592-3392
Mailing Address: 905 Coharie Dr Clinton NC 28328
Physical Address: 1421 Concord School Rd Clinton NC 28328
Facility Status: Compliant Not Compliant Integrator: Murphy -Brown LLC
Location of Farm: Latitude: 34' 59' 11"
Hwy. 24 from Clinton at Concord cross roads take right - 4 miles down on left.
Longitude: 78' 26' 42"
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Clifton Daniel Tyndall Operator Certification Number: 989946
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Mike Ammons Phone:
On -site representative Mike Ammons Phone:
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Robert Marble Phone:
Date:
page: 1

Permit: AWS820254 Owner - Facility: Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 10/17/13 Inppeclion Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
❑ Swine - Wean to Feeder
Total Design Capacity:
Total SSLW:
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
1
24.00
Lagoon
2
24.00
Lagoon
3
24.00
page: 2

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 10/17/13 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharas & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑ ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
❑ ❑
❑
b. Did 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 observable adverse impacts or potential adverse impacts to Waters of the
❑
❑ ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
❑ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
❑ ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑ ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑ ❑
❑
S. Do any of the structures lack adequate markers as required by the permit? (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
❑
❑ ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ❑ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ ❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 820254
Inspection Date: 10/17/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
WasIR Application
Yes
No Na Ne
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
1111
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑ ❑
❑
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑ ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
❑ ❑
❑
Records and Documents
Yes
No Na Ne
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
❑ ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
❑ ❑
❑
If yes, check the appropriate box below
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21, Does record keeping need improvement?
❑ ❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS820254 Owner - Facility : Goshen Ridge Farms L Facility Number: 8220254
Inspection Date: 10/17/13 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No No No
Crop yields? -
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑ ❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑ ❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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 phosphorous loss assessment (PLAT) certification?
❑
❑ ❑ ❑
Other Issues
Yes
No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑ ❑
❑
and report mortality rates that exceed normal rates?
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 regional DWO of emergency situations as required by 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
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
❑ ❑
❑
CAWM P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
❑ ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
❑ ❑
❑
page: 5

i ype ut visit. w 4ompuance inspection V uperanon Keview v nrructure tvaluation CV i cennicai Assisiance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: vtl�
Farm Name: /\kV Sey__iP.S Owner Email:
Owner Name: _ �l%1i(jp,1r1 I ac Phone. -
Mailing Address:
Physical Address:
Facility Contact: ' "4 An
l„v„uo;, j' Title:
Onsite Representative: It
Certified Operator: v' �►7-�+p�^
Back-up Operator: y1 S
Phone:
Region: ('
Integrator:
14,L
Certification Number:
Certification Number:
7��lJ
Location of Farm: Latitude: Longitude:
`DesignCurrent
Swine Capacity Pop.
DesignCurrent
Wet Poultry CapTacity :.Pap.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder p
Non -La er
Dai Calf
Feeder to Finish
s " -
Dai Heifer
Farrow to Wean
i D"esign Current
D Cow
Farrow to Feeder
D IPpult ,Caaei P.q
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
,,...,
s _
Turkeys
-
Other
Turkey Points
Other
Other
Dischar es and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 � No ❑ NA ❑ NE
[3 Yes [] No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes No
❑ Yes No
NA ❑ NE
NA ❑ NE
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Type of Visit: 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: & Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: qi� Arrival Time: Departure Time: County: �_'W Region: FW
r
Farm Name:L;Gf5k,1.LtI 5i P.S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /M r Le Title: Phone:
Onsite Representative: y Integrator: 1,
Certified Operator: V'�T�' ����iD�►
Back-up Operator: At-14; i4M iyoi
Location of Farm:
Latitude:
Certification Number: 2w `],6
Certification Number: i3,7 0 4
Longitude:
* 36i Cur nt
gn
Desi ' Current l
gn
Design Current
Swine �Ca c Po
p
Ca aci Pop.
Wet Poultry p ty °
F
`
Cattle
Capacity Pop.
o Finish
Layer
Dai Cow
o Feeder 10
Non j er
Dai Calf
to Finish
_
"'
Da' Heifer
to Wean
Design _Current
D Cow
to Feeder
D .P,aul
C aci - : Po
Non-Dai
to Finish
EFa
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [] Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[—]Yes ® No ❑ NA [] NE
❑Yes
No
©NA
❑NE
❑ Yes
❑ No
C' NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [::]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ 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
21412011 Continued

Facility Number: - Date of Inspection: j Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 Z 17
�No ❑NA ❑NE
❑No NNA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in): u
Observed Freeboard (in): 3 sit r 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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
W 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
W No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:)Yes V] 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): at?S� i i � ��-.dl.� ( ri S ��5�•0 �1 � A. (J J'1 ``��
13. Soil Type(s): %1v4tI Y---INk A, kh C1im.,
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
r No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[S No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reguired 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
[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 [P 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 `P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

C,
Facili ' 'Number: jDate of Inspection:
Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
® No
❑ NA
E] 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
J?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(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
® 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V 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 n❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crap TYpe(s): �Cl � �Q/ Y*,rJl � tr�A S 1. !'-�SCe.D C. ��1�'�"P l,�"i • i��'�+l"► ��%P _
11 Soil Type(s):Dti7oE,.�--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W, No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
®, No
❑ NA
❑ NE
f
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
r
® No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�� No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: jDate of Inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 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 t@ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EA 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?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
M
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
�5No
❑ NA
❑ NE
❑ Yes
5] No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
Phone:
Date:
21412011

FaciliNumber: - Date of lns ection: ?'
\
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
bg No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
`
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ 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
b5No
❑ NA ❑ NE
1. ..
33.'Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes]
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
0 NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or�any additional recommendations or any othery om3 menu.
:b
Use drawings of facilitygto-better;explain situations (use:ad�honal pa�es.as'necessary).
`�pCr�s f2tfl 5/1't3�12r
sr ►ll�lJ bti' fV►S2�r��
Reviewer/Inspector Name: TO 6A fvwl�p Phone:
Reviewer/Inspector Signature: i�t.�9„{ Date:
Page 3 of 3 21412011

I ype of visit: W Compliance Inspection V Uperation Review V Structure Evaluation U Technical Assistance
Reason. for Visit: 0 Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I �f �9i J (� Arrival Time: Departure Time: County: s W
Farm Name: S�dr, /VU4-5erj`P_5 Owner Email:
Owner Name: Mu ro�YiQWvl, Li-C-, Phone:
—�•:
Mailing Address:
Physical Address:
Facility Contact: M 1 4 >q-ry r"'OiiTitle:
Onsite Representative: >h
Certified Operator: U ICU- 14 r]
Back-up Operator: 4e yrQ #15
Location of Farm: Latitude:
Phone:
Region: 02
Integrator: " -)%0cdYl, az-
Certification Number: n�6o ! a
Certification Number: ` 65g9y
Longitude:
Desi n CurrentrK Design Current Design C►urrent
g� +.
Swine Capacity Popy� WetgPonitry _ *.Ca`p�acity Pop.C-attle - Capacity Pap.
Wean to Finish Layer Dai Cow
Wean to Feeder 10 4co 1 Non -Layer Dairy Calf
Feeder to Finish I Dairy Heifer
Farrow to Wean Design Current Da Cow
Farrow to Feeder D *P ult Caaci P,a Non
Farrow to Finish Layers Beef Stocker
Gilts _ Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Qther Turkex Poults --
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑Yes
❑No
NA
❑NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No n NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V) 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 8 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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? P
Waste ADDlicatiOn
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 P 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 lWind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s). l.[ ,�`flI l ► +�'1 �SS V t�l' ) j PeC t , v-rruri
-
13. Soil Type(s): o4khaaw
14. Do the receiving crops differ from those desi ated in the CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:)Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes M 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 M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [5 No
❑ 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 J�j No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Eg No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes " No ❑ NA ❑ NE
❑ Yes ® No [] NA ❑ NE
❑ Yes Qg No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes " No
❑ Yes Fj No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c.i
Reviewedlnspector Name:
Reviewer/Inspector Signature.
Page 3 of 3
Phone:
Date: i c
21412011

3S"
y, y,�„
3a y3.

Date of Visit: ( 0 Arrival Ti Departure Time: 4 County: Region:
a � t
Farm Name: .5� h � e _ Owner Email:
Owner Name: 6 96A-e ` 91� Phone:
Mailing Address:
Physical Address:
N
Facility Contact:jA Title:
N
Onsite Representative:
Certified Operator:
Back-up Operator: D241 fj ��
Phone No:
Integrator• ►' f�/]
Operator Certification Number: r�
Back-up Certification Number:
Location of Farm: Latitude: = o =,
= Longitude: = e = i = u
Design Current
=-
Design Current
Design C►►arrent
Swine Capacity , Population
Wet Poultry.'FaCapa
c�iTtytP lation
Cattle Capacity Population
❑ Wean to Finish
❑ La er'-^
❑ Dairy Cow
Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish�F��h
Dairy Heifer
❑ Farrow to Wean
r
D Poul x a3
ry
El Dry Cow
;�
El Farrow to Feeder `
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
El Gilts
El Non-Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turke s
-
❑ Turkey Poults
❑ Other1110
Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
Y No
❑ NA
❑ NE
Discharge originated at: ❑ Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Cl Yes
❑ No
[PNA
lP
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
ElNo
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (Iryes, notify DWQ)
❑ Yes
❑ No
)9 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(V No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1P No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection l 51
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IrNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [�TNA ❑ NE
Stru tore I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r�
Spillway?:
Designed Freeboard (in): 17
•/
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
f
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes No
V
❑ NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windo Evidence of Wind Drift ❑ Application Outside of Arear,,,,
Crop types) R'fA ada \'�Pk'tq �� : StA,
ya4vlot
J12.
�&. �1d
13. Soil type(s)
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain -any YES answers and/or any recommendations or any other comments.
Use drawings of facility to.better.explain situations (useadditional pages as necessary) � F
Reviewer/inspector Name _ Phone:
Reviewer/Inspector Signature: Date: S O
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection Erl,70
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
to 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
P] 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
1] 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
[PNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L f j2/��1 Arrival Time: ;(,rJ Departure Time: I f?I tAO� County: S P_W Region: _ P-
Farm Name:sOwner Email:
Owner Name: _ U �V +�, C.�C Phone:
Mailing Address:
Physical Address:
Facility Contact: �f', 1� kPyylp" 5 Title:
u
Onsite Representative:
Certified Operator: �J! � 11 QtT'1 6I.c44y rl
Back-up Operator: Q
Phone No:
Integrator• tGL
Operator Certification Number: ZO 7^'
Back-up Certification Number: aB w�
Location of Farm: Latitude: [=]' =' = Longitude: = ° =' = «
Design Currenti _
Design Currents _ ,;: Design Current
ine
6601 opulateo.n Wet Poultry
. @apac17 1'opulation4 t Capacity Population
Wean to Finish
❑ La er
{TCattle
❑Dai Cow
Wean to Feeder
FFeeder
❑Nan -La erg
El Dairy Calf
to Finish
tl
El Dairy Heifer
Farrow to Wean`
Dr.fl. lit
s
- '` ❑ D Cow
❑ Farrow to Feeder
"' ❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layer s]
Beef Feeder
PE313oars.
ElPullets
ElBeef Brood Car
Other
❑ Turkeys
; ❑ Turkey Poults
❑ Other _
❑Other
Number of Structures:
--
r
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes [�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
�NA
(NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
[I No
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
43 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
M No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
glNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i a 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA [INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes � No El NA El 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 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes fftNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes No [I NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding []Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) &, Ja 6?�5A� )1 i- s "`2 i ' G5� �j sk . &- 0&e=-
/
13. Soil type(s)
�,yh— Va8
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[pfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
; No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Reviewer/Inspector Name Phone: 0-� 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number:W—zq Date of Inspection 0
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V�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 approprrate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 19 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9 No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
64No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes]
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
$1No
❑ 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
[14No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
%No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�SNo
❑ NA
❑ NE
Page 3 of 3 12128104

E
Faeility Number
Division of Water Quality
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 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: � County: Region: �L
Farm Name: �` n,� h� Owner Email:
,,��
Owner Name: QYL it t— r _ Phone:
Mailing Address:
Phvsical Address:
Facility Contact: 01 AD- (xm�cs Title: _ W q) Phone No:q, C) s2S1-0►
Onsite Representative: Integrator: 01 —$
Certified Operator: yn rix4x Operator Certification Number:
Back-up Operator: Back-up Certification Number: go- r
Location of Farm: Latitude: = n Longitude: = o +�
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
tDL❑Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: a]
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 IQjNo ❑ NA ❑ NE
❑ Yes
❑ No
[�NA
❑ NE
❑ Yes
[]No JN NA
❑ NE
ANA
❑ NE
❑ Yes
❑ No
❑ Yes
H No
❑ NA
❑ NE
❑ Yes
b No
❑ NA
❑ NE
12128104 Continued

Facility Number, a _ 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?
❑ NA ❑ NE
❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2-
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in): d
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [9 No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes ANo
❑ Yes )j�No
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 blNo ❑ 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?
WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes (� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ }heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acgeptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(VNo
❑ 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):
- ( p P roe eSs � s /Udsf ckan aJ 0-n -:Y-- 3 , la,-r s-F-F r &4 "T -
Reviewer/Inspector Name
ReviewerAnspector Signature:
Phone:
Date:
12125I74 (.onnnuea

Facility Number: Date of Inspection E D11oj� J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the approprrate box.
❑ WIJP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
C6JNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�] No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[`,NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit`? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency'?
❑ Yes
MNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility No, T Time In Time Out Date
Farm Mame sk�' k 1/yJ[.r,='G� Integrator /«
Owner �- Uf PQ r P4,S LLC Site Rep
It
Operator �L.1? n' No. -
Back-up cis ^�tA hw No. O� 1
COC le: ener or NPDES
1041
De si n
Current
Design
Current
Wean — Feed -
DD
Farrow — Feed
can — in is
Farrow — Finish
Feed — FiniSh
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design C p Sludge Survey
* 2't 3
Observed Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge 7 Rain Breaker
Soil Test ram_ Wettable Acres �eu,�y PLAT
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
120'min Inspections
Date Nitrogen (N)
3 I
zo
1-in Inspections
Date Nitrogen (N)
5')3� 1.0 a--1 2
G t�
Pull/Field Soil Crop Pan Window
Yl Rly kkr
$� C u
0

1 '1'
Facility Number
0 Division of Water Quality
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 IS Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Tzkxn
Arrival1Time: (� O Departure Time: � County: �Dn
Farm Name: KVU.f t`. Owner Email:
Owner Name: t 0 Rk *-- m S Phone:
qzb
Mailing Address:
Physical Address:
Region: ��
Facility Contact: Title: LN `'' __ Phone No:
Onsite Representative: oA oirn 10-as _ Integrator:
Certified Operator: - �� mm cx- __ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 00 [=]' =" Longitude: =0
=1 =
64
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Q pp D ❑ Non -La et I I j
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
Non-Dai
Ll Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
Is any discharge observed from any part of the operation? ❑ Yes XNo ❑ NA El NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No *A
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El
[I No �A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NoZ�g NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
GNo El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
El No l�lA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: Z.. Date of Inspection Il �-I IsSlo 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N(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
ANo
❑ 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 ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA ❑ NE
maintenance or improvement?
JMNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
io
❑ NA El NE
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
uu��
�Vo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of AccceplWindow El Evidence Wind Drift El Application Outside of
Area
12. Crop type(s) >n utable -Chop, +of
-& „ f l`l r
._&Y
13. Soil type(s) VIA
14. Do the receiving crops di r from those designate in the CAWMP?
❑ Yes
� No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
15�No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1-No
❑ NA ❑ NE
Comments (refer to question-ft++Explain any YES answers and/or any recommendations or any other commence: I ""
Use drawings of facility to bette explain situations�(use additional pages as necessary):
Reviewer/Inspector Name $-rJ C 7`' Phone: 114 /0 M 313 0
Reviewer/Inspector Signature: Date: �L
Page 2 of 3 12128104 Continued

Facility Number: Z — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ 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 V Rain Inspections ❑ Weather Code
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
KNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�rNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PkNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
j; NA
El NE
Other Issues
//
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;&No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
bQ 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
ANo
❑ 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
N 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
J�,No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Additional Comments and/or.Drawings: h; .
7/LQ-t,- u"e- Ye�o"d 6*LTYM
CS�UnC'e�
IC'.V.r -6d-
odedl
//
j( -t ✓Lt C.'tU.r-t &--'t � P4__1
5A
Page 3 of 3 12128104

Facility No. d`- Time In Time Out Date Y(
% AA n
Farm Name ,j2QSj.4,Slc ;, IVy-AJzzxg,� Integrator I
Owner �Qpv� 12,c� „ �L Site Rep
Operator No. oW .
Back-up No.
COC Circle: (,GeneralD�r NPDES
Desi n
Current
Design
Current
IN
O Yc5i�)
Farrow -Feed
Farrow - Finish
Feed - Finish
Gilts I Boars
Farrow - Wean
Others
F OARD: ign `
Sludge Survey
Crop ie
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Observed
Calibration/GPM 1
Waste Transfers "—
Rain Breaker
PEAT
Daily Rainfall 1-in Inspections
120'Tfiin Inspections
Date Nitrogen (N)
11 20 FS
1
z-"S' z %s
Date Nitrogen (N)
o 7,� 2.Y
y 3.0
3 hL 2,11 1. 7
Pull/Field Soil Crop Pan Window
NJ 0Ak
U
C C) `�

16-
IType of Visit 4P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint $Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: 3: o ] ��.Al!rrival Time:5� Departure Time:v County:
Farm Name: JJ6i' n
Owner Email:
Owner Name: _�R eM, 0M . &,rJ C d tip-t 5 . C . Phone: _
Mailing Address:
Physical Address:
Facility Contact: f1 Title: L'
Onsite Representative: _� � t�
Certified Operator:
Back-up Operator:
Phone No: J
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region
Location of Farm: Latitude: 0 0 F--I [ = di Longitude: 0 ° = [ = W
Swine
❑ Wean to Finish
Design @urrent
`Capacity l'oLpulation
Wet Poultry
10 Layer
❑ Non -Layer
Design @u�rrent
C•apa�cityPopulahon
Design Current
CattEe C*apacity Population
❑ Dairy Cow
❑ DairyCalf
:,
❑ DairyHeifer
Dry Poultry
.' 3Ys
r,w
❑ D Cow
t;.:. z.::�...�
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑ Non -La ers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
Other , ^
Turkeys
❑ TurkeyPou Its
_-
❑ Other
❑Other
Humber of Structures:
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharces &Stream Impacts
1.
Is any discharge observed from any part of the operation?
El Yes
Wo
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
093NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
�IA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑Yes
❑ No
M"NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
;VNo
d NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
MNo
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
I2/28/04
Continued

Facility Number -
Date of Inspection d•
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 Structure Structure 3 Structure 4
Identifier: 3
Spillway?: q q
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes oNo ❑ NA ❑ NE
❑ Yes ❑ No *A ❑ NE
Structure 5 Structure 6
❑ Yes VNo NNA ❑ NE
❑Yes NNo El NA El 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 h No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes N 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 Wo ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA WNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No ❑ NA �JYE
❑ No ❑ NA �ZNE
❑ No ❑ NA NE
❑ No ❑ NA NE
❑ 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):
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone: y % 0
Date: _ TA
12128104 Continued

Facility Number: =` Date of Inspection
Required -Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ONE
the appropriate box.
❑ WUP ❑Checklists ❑Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA WE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ tNo ❑ NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes (*o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes , ❑'No ElNA WE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes ❑ No ❑ NA E
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ElNo ❑ NAfN
E
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes El No El NAE
Other issues
2$_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA *E
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA WNE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA /� NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA
iE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes El No ❑ NA � NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA NE
Additiohal,,Coinments and/or Drawings:
. U
Skid Le mil" b
� S&-� .
Page 3 of I2128104

.2
Type of Visit d jCommpliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 04ol utine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 10 2.� Arrival Time: Departure Time: ® County. Region: 4LO
F
Farm Name: 6 1 Owner Email:
Owner Name 6 O`Vyy`._ _'� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 44 n� 0.Yl h • S b�ot�ei"
Ir
Certified Operator:
Back-up Operator: �-
Phone No
Pte, -t, 54,4
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o [ • =it Longitude: ❑ o = 6 ❑
it
Design Current
Design Current
Design C•urreat
swine
Capacity Population
Wet Poultry Capacity Population
Cattle @apacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
5RnycantoFeedqeLr_Voq<,o
I '-]y
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
d �
❑ Dairy Heifer
❑ D Cow
Dry Poultry w
❑ Farrow to Feeder
`mow ElNon-Dairy
❑ Layers ❑Beef Stocker
❑ Non -Layers
❑ Pullets ❑Beef Feeder
❑ Beef Brood Cow
OWN - ❑ Turke s
Other ❑ TurkeyPoults
❑ Other ❑ Other Number of Structures:
❑ Farrow to Wean
❑ Farrow to Finish
❑ Gilts
❑ Boars
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 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 l of 3
❑ Yes a No ❑ NA ❑ NE
❑ Yes
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 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 l of 3
❑ Yes a No ❑ NA ❑ NE
❑ Yes
❑ No
10 NA
❑ NE
❑ Yes
❑ No
C3NA
❑ NE
J&NA
❑ NE
❑ Yes
❑ No
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
�&No
❑ NA
❑ NE
12/28/04 Continued

Facility dumber: — Date of Inspection w �3
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: j c2
Spillway?:
Designed Freeboard (in): c;2 t /r j`
Observed Freeboard (in): l f 3 d� 5
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 $4No ❑ NA ❑ NE
[-]Yes ❑ No 5i NA ❑ NE
Structure 5 Structure 6
❑ Yes
7No
❑ NA
❑ NE
❑ Yes
EfNo
❑ 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 Eb No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9No
❑ 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
V No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(51No
❑ NA
❑ NE
maintenance/improvement?
IL _ Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
j2rNo
❑ 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) &I mu Aq, m C ►- ' V
13. Soil type(s) QLV o `��— �J o,V�f`
14. Do the receiving crops differ from those designated in t e CAWMP?
❑ Yes
No
ZNo
ElNA
[INE
15. Does the receiving crop and/or land application site need improvement?
ElYes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�K No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
' 3, No
El NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
4No
❑ NA
❑ NE
Comments (refer.to question #): Explain any YES�answers and/or any recommendations or any otber"6mments -,
Use drawings;of facility to better explain situations (use additional pages as necessary):'
ecessary) AL
� e.�.��.�+� s � our t�►i � �p i [m�.r
vi
Reviewer/Inspector dame f ' Phone: 14 L 3-31 33
Reviewer/Inspector Signature: Date: to C 2
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JNNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �5 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )RtNo ❑ 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
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
a No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
$No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tgNo
❑ 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
R 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
bNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ED4o
❑ NA
❑ NE
Addiizonal�Comnneutsand/ar Drawings:
Page 3 of 3 12128104

a - ° Time In r 7 Time Out Date r 02
Facility No. `
Farm Name Y Mu ; �S Integrat�Jc= SA
Owner rav $ Site Rep + i
Operator zI >�YYIQX. No. �9
Back-up i No. a
COC {f Circle: General or NPD
I�
Design
Current
Design
Current
Wean - Fe
O pc�
Farrow - Feed
can -Finish
Farrow - Finish
Feed -- Finish
Gilts / Boars
Farrow - Wean
Others
FREEBOARD: Design yM J';4" Observed
Sludge Survey
Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge / Rain Breaker
Soil Test PLAT V �� �'' Wettable Acres
Weekly Freeboard L---�_ Daily Rainfall- �� 1-in Inspections
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
l.y
Date Nitrogen (N)
5 ,3 a . z I
3
V/? 2 • o / 3 , r j2 •y
Pull/Field
Soil
Crop
Pan
Window
a
311-
bo
r- - y
31L— a
CQk
1

l
40 Division of Water Quality.
Facti�ty,Number . g� ' 0 Division of Soil and Water Couscrvation b
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: _ Q+ti Region: tA942
Aw.
Farm Name: 06 P_skvsser_<es __ _ _ __ Owner Email:
Owner Name: �6-o-Aen- RA., ,aem & -, L L C Phone: J/ ef - oa - _2/0y
Mailing Address: P O. RON- •„ 3 y y NC 0 83.29
Physical Address:
Facility Contact: Telee.,,. H./1 Title: _
Onsite Representative: .� �G�r 2.'..h.n�/
Certified Operator: -.ec
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:. / re n 1 v.-+
Operator Certification Number: 2591
Back-up Certification Number:
o
Latitude: g ❑o�s
� � � Longitude:
d 00
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
2-Wean to Feeder
Other
❑ Other
Dry Poultry
❑ La ers
ElNon-Layers
❑ Pullets
❑ Turke ys
❑ urkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
El Dairy Calf
El Dairy. Heifer
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
ElBeef Feeder
ElBeef Brood Cowl
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)?
Number of Structures: L'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
?. Is there evidence ofa past discharge from any part orthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
El Yes [31�o El NA El NE
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
El Dairy Calf
El Dairy. Heifer
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
ElBeef Feeder
ElBeef Brood Cowl
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)?
Number of Structures: L'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
?. Is there evidence ofa past discharge from any part orthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
El Yes [31�o El NA El NE
❑ Yes
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)?
Number of Structures: L'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
?. Is there evidence ofa past discharge from any part orthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
El Yes [31�o El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
E3,No
❑ NA
❑ NE
12128104 Continued

Facility Number: B> — �, Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Spillway?: Ao
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2' to ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2'Ko ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2& ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E;'No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
2f,4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
0 o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s)
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
90No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes
.n
X WNo
❑ NA
Q'1�TE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
[111E
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
!ne %Ca lase ,,,, 13fe- C""Sle /,4, C, .// 6e 6.�1�.. Gfdwn ,%rTn Pr��S rf,S �.eb�
6r�'drt f-he ""7 G/'ate ,'S o14n1eW, ,d Ae l4.lie ,s& nP" w;/I 4!
1l7 It tow Crpr ros�/.w�.
c Qs �rLY er Ir ,, al/ lk4leC /p s
Reviewer/Inspector Name Phone y/U- LAC �,. ..
Re-viewer/Inspector Signature: Date: ,-a V-oy-
12/28/04 Continued

Facility Number: -2 )a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [xNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9-No ❑ NA ❑ NE
the appropirate box. ❑ Mew ❑ O� ❑ ❑ C> ❑ fists n
21. Does record keeping need improve ent? If yes, check the a propriate box bel w. El Yes El No El NA El NE
g
❑ ❑ ' ❑ i❑ ❑ ❑t�ual�e#ation
❑mall ❑wig ❑— ❑ ❑ s ❑
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility tail 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 CA1'IWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems. over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[�J'No
❑ NA
❑ NE
❑ Yes
D-ICfo
❑ NA
❑ NE
❑ Yes
gfgo
❑ NA
❑ NE
❑ Yes
. M-No
❑ NA
❑ NE
❑ Yes
2 too
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes E 'Mo ❑ NA ❑ NE
❑ Yes PNO ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes 2"No ❑ NA ❑ NE
❑ Yes 2-*No ❑ NA ❑ NE
Addkiotial t6flaments and/or Drawings:
44�a3 R4,n 9ta/!e, 04 One O!� Thy �bn�S tva5 Gto�![it. 7-4[ of r �iRGC u SPLi�
12128104

Type of Visit GYtornpliance inspection O Dperation Review O Lagoon Evaluation I
Reason for Visit 044outine O Complaint O Follow up O Emergency Notfication O Other ❑ Denied Access
Facility Number µ Date or Visit: 3D i7 Time. ��
O Not Operational Q Below Threshold
U Permitted © Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: --- _» —
r 7N
Farm Name: X � rhl� County: ,._... 5!�......
Owner .._..._..._.�...
Owner Name• Phone No: ;2104
Mailing Address: b.... x .. 3 .............._ .....". - ......5�1_ v! ...... P C ....... __.. ...... _ S .�t 9........
Facility Contact r..... _ ................_Title:.......... ....—__.�....W.... Phone No:Contact: ....... ........... �--......_Gt
Onstte Representative: Integrator.
p _. �....W &.' 41t-__......._...._..........�..... -
Certified Operator: Z'-WL 'er. Operator Certification Number: 9591
Location of Farm: �J
Mswine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ����
Discharges & Stream Irnaacts
I . Is any discharge observed from any part of the operation? ❑ Yes 014o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes EX/0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [I Yes Q"1`lo
Waste Collection & Treatment ,_ ,!
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El Yes U o
Structure I StructuLe 2 Structure Structure 4 Structure 5 Structure 6
Identifier: _..... ............ ........ ..... of
........ ................ _,....... ......... .......... .......... ........... ... ...................... ..................
Freeboard (inches): 4 So q_]
12112103 Continued

Facilt'ty Number: 2S
Date of Inspection D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
CIoStl1'e plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancehimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ��l t Si►+.�1 � a DNS _ (4a 4<A _ --
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 1i o
❑ Yes [Jib
❑ Yes t 0
❑ Yes Q No
❑ Yes fi]�No
❑ Yes ,8.,,'10
El Yes L7no'
❑ Yes io
❑ Yes 2140
❑ Yes [wo"
❑ Yes D10—
❑ Yes ❑4<
[:]Yes RNO
❑ Yes B'f10
❑ Yes 2''No
❑ Yes [rlo
❑ Yes [jr"N'o

Fac2ity Number: J.9 —' Date of Inspection K o
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )VIJP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3 I -35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [:]Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes EKO
❑ Yes ®No
❑ Yes M o
❑ Yes Eg No
❑ Yes [ 44o
❑ Yes Rfio
❑ Yes PNo
❑ Yes (l10
❑ Yes IKo
es ❑ No
❑ Yes [ Ro
❑ Yes Rgo
❑ Yes &KO
❑ Yes To
❑ Yes 94,0
12112103

Site Requires Immediate Attention: NO
Facility No. ITZ - 2 SQL
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Ausu x,F Z , 1995
Time: w " 2` Z
Farm Name/owner: 8e., ✓ sK" f✓ Ill, -Se ry / t-A Sroe- f %
Mailing Address: /e�' 6, rax 31'f Cl,,v A,.j NC zg 3 zs
County: S.-ML0 xeN
-Integrator: . _ Neu reT s«, /y Fru..�s Phone:
On Site Representative: ll�vfd � N - � Phone: r9/0j 5-6 V- — &/2 -3 a r 4475z
Physical Address/Location: 52- I -Z-q-0
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: z, 60o A tact,, Number of Animals on Site: z, bd o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' , " Longitude: ° ' "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) �e or No Actual Freeboard: 4 Ft. 4 Inches
Was any seepage observed from the lagoon(s)? Yes o(�W Was any erosion observed? Yes ord&D
Is adequate land available for spray? �neDp r No Is the cover crop adequate? for No
Crop(s) being utilized: f A sue►- RDu3 C ,:;-
•Does the facility meet SCS minimum setback criteria? 260 Feet from Dwellings? or No
100 Feet from Wells? for No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ordQ
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or®
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orcgi;? If Yes, Please Explain.
Does the facility maintain adequate waste management =ors (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
Additional Comments: Zo560^1 E.6 s 6-c-" 0-cJ'C-5- "j '
9tG /2 .,els
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: NO
Facility No. SZ - z 55
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: use- Z , 1995
Time: /v
`Farm Name/Owner: Z / E//; o /4 Sjoe //
Mailing Address: & 3� X 3/ e /inr-/X' n/ /NG Z8 3 z 8
-County: Sa •+,Ie sa.V--
-Integrator: u I F r Phone:
�On Site Representative: rave SeryAje-4a— Phone: KWO) 5-6 $4 — 6133
Physical Address/Location: SA rZ*-0 _.
Type of Operation: Swine ri Poultry Cattle
Design Capacity: ?, (20o Xp5tj2) Number of Animals on Site: -46 go
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) (j§j)or No
Was any seepage observed from the la oon(s)?
Is adequate land available for spray? or No
Crop(s) being utilized: C:
Actual Freeboard: 44 Ft. 4 Inches
Yes orb Was any erosion observed? Yes or
Is the cover crop adequate? JWor No
Does the facility meet SCS minimum setback criteria?" 200 Feet from Dwellings? �esior No
100 Feet from Wells? (I!E�br No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orb
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or® 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)? c�r No
Additional Comments: La �," ;red
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Farm Name/Owner:
Site Requires Immediate Attention: Nd
Facility No. SZ - Z 5�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: A -2OAs+ a, 1995
Time: f 5 54
Sta6r5kAj - Pc,44.v_aof dvvseY4,
Mailing Address: 94 Cn C/;, 4.j N z s3Z S . ---
'County:_ $aL"4snoy T
Integrator: A6,Pk4 r-g.. ;L; Ga kkt__ Phone:
On Site Representative: t>a ,A Phone: C91v S6 54 73
Physical Address/Location: 54 ► �� 0
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 2, &oo NUv-5 , Number of Animals on Site: Z boa
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) QR or No Actual Freeboard: Z Ft. o Inches
Was any seepage observed from the lagoon(s)? Yes o>!NDWas any erosion observed? Yes or®
Is adequate land available for spray? Oor No Is the cover crop adequate? (!G) or No
Crop(s) being utilized:_60a!;-4_/ , e,.,,j Cry
Does the facility meet SCS minimum setback criteria?
s
200 Feet from Dwellings? des or No
100 Feet from Wells? dIR or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orW
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orb
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(%� 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)? eor No
Additional Comments:
Re-vefs _
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.