820260_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qua

[TO
(Type of Visit: 0"Com .ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrivai Time: pa Departure Time: Q ; 00 County: w Region:
Farm Name: _713 dr Ala!��,� _
Owner Name: D/7/'I % r--
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: 17Y Phone:
Onsite Representative: �� Integrator:
Certified Operator: si�ca{� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Desigp Current
Desige Current
Design Cnrrent
Swine
Capacity Pap.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
°' E�!,�,,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult Ca aci plop.
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Oii�er
F—T(7h-
Turkey Poults
.. Other
µ
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �O No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes ❑ No
❑ Yes ZC No
❑ Yes JRJ No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3
21412015 Continued

-IFacility Number: & rJ Ds ection: — O/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?-.
Designed Freeboard (in): Z _ 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes []"No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Q No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes No ❑ NA 0 NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [a'<o 0 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 El"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes El -No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [-]Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): r/L$YY
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
L3/No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EaNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
[DNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
O Yes
[DIN0
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[7 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 Ea -'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii 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? El Yes [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj"No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of las ection: —(o--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes Q 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
[] Yes
Ej No
❑ NA
❑ NE
❑ Yes
[.31�0
❑ NA
❑ NE
❑ Yes [3No
❑ Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
eNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E]INo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[fNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ter No
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3-No
❑ NA
❑ NE
Comments (refer to goestio�a Expl>rrn an jYES=answers and/or any adcf�tional recain endations or,any other coma ents r
xap „ ,1iN,Eg91 1,. PJdE d Y:� N N «:.
Use drawmgs4 facrlity�to'lietter exp[a[n srtuahons�use additional pages'as necessary) k _��z „
Reviewer/Inspector Name: Y�/�- / (�=\AJ'4 Mr6 Phone:
Reviewer/Inspector Signature: fv Date:
Page 3 of 3 21412015

r
type of Visit: k-'r{Ampllance inspection U Operation Keview u structure Evaluation O Technical Assistance
Reason for Visit: Orl routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: P- / Arrival Time:'-f—� Departure Time: a ; 5 ram. County: D-z,_ Region: � D
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Entail:
Phone:
Facility Contact: ri r7H t ��m e 7A_ Title: Phone:
Onsite Representative: �S ���, Integrator: ��f�2% 1 t?/C/
Certified Operator: Certification Number: / TLT15_/
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
°;
Design Current
1 I�I� Alll
Design Current ,
iJlll 1 k �11�� !'
Design Current
I
Swine
Capacity: Pop.
Wet Poultry
�ECapacity Pop 'i
Catt[e
Capacity Pap.
Wean to Finish
La er
DairyCow
Wean to Feeder
(
yDtJp
Non -La er
Dai Calf
Feeder to Finish
I''I R�!I,'' 'l;
DairyHeifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
D , Pout
Cac"i
Po
Non -Dairy
Farrow to Finish
Layers
`
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
!
Other
-Turkey
Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of tt)6 State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes allo 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes RNo
❑ Yes 0 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

'IFacdity Number: - DateofInspection: D—
--!?
f Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
jg No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[& No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
0 No
DNA
D NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes RNo ❑ 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): �y-m M
13. Soil Type(s): 4,4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EjNo ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes 5a 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? If yes, check ❑ Yes Ea -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. 0 Yes ELN
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RN
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - (per DateofInspection: 71
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWM P?
33. Did the Reviewer/Mspector 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:
ReviewerAnspector Signatui
Page 3 of 3
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes )A No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes fo No ❑ NA ❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[C No
❑ NA
❑ NE
Phone: 222 3C13--6 h
Date. 1,9
21412015

r/
ivtsian of Water Resources
Facility Number - {v D ®Division of Soil and Water Conservation
- � Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: e-910"utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — ,3— Arrival Time: O Departure Time: a County: Region:
Farm Name:— f�., r r+., f Owner Email:
Owner Name: /�g, �; ,� <jm; 7�1 Phone:
Mailing Address:
Physical Address:
Facility Contact: �� r7 ; r- � yy,; Title: �Zyiz- ' ` Phone:
Integrator:
Certification Number:
Onsite Representative:
Certified Operator: 5�---
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Castle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder a
I
lNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P�oul
Ca aci
P,a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes ❑ No
❑ Yes UNo
❑ Yes ELNo
❑ NA [ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

FacilityNumber: - (� Date of In ection:
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
® No ❑ NA ❑ NE
❑No [DNA ❑NE
Structure 6
❑ Yes [S No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[RNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E4 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
[S 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 JZ[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 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ZY/'muy O 4-2i�ikIY,_j
13. Soil Type(s): au,
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes Jallo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ERNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P�JNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ®. No ❑ NA ❑ NE
[—]Yes ®,No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Eallo [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�jNo ❑ 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 Cj�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EZ� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 8 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - p Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2!�No ❑ NA ❑ NE
r
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 ,E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
B 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
[Z 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
Jallo
❑ 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
[5-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
Callo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[allo
❑ NA
❑ NE
Reviewer/Inspector Name: Phone:
j3 c�
Reviewer/Inspector Signature: Date: 20/1
Page 3 of 3 21412015

7-17-/S v
Type of Visit: OTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: t1coutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of visit: 7 / Arrival Time:E75-6-1 Departure Time: County::.:M" Sa�—
Farm Name_ �.t(�,����r-y / �'�- Owner Email: -'`�`'�
Owner Name: �h n ,, _S�; T Phone:
Mailing Address:
Physical Address:
Facility Contact: An tie r� ,w 77A Title: ,9i�jn�_� Phone:
Onsite Representative: j ,,�� Integrator: 1771'
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:Ep
Design Current
=
Design
_Current
Design Current
Swine
Capacity . Pop.
Wet Poultry
La er
Capacrty
Pop:
Cattle Capacity Pop.
Da' Cow
Wean to Finish
Wean to Feeder
Non -La er
"`
-
Da' Calf
DairyHeifer
Feeder to Finish
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P■oul
Ca ' -
._P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
Other _
Turkey Poults
Other
Other
Discharzes and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E jNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
MNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate 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 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): 1-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P3,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
5jNo
❑ 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
i No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[Z 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?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®, No ❑ NA ❑ NE
❑ Excessive Ponding ❑ HydrauIic Overload ❑ Frozen Ground ❑ 1-leavy 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): �jCtlar�f2 f'�rr� .
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [. No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C& No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes r No ❑ NA FINE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes nNo ❑ NA ❑ NE
❑ Yes (�d No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes La No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ER[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 .R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
Rainfall D Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

' Facility Number: - Date of inspection:
f
°f 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA ❑ NE
w
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 to provide documentation of an actively certified operator in charge?
❑ Yes
CS No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Da No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
[] NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® 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
IS No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R—No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ No
❑ NA ❑ NE
Useommen s(re er o. uestion Explain
pn any (andar:any additional recommendations or. any,
dra#obeter explain situations use additonlpsof faciTy tiages other comments _ � � 3
as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: r
21412011

me
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Gqtoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 'pp Departure Time: ! 3 (? County; �-- ;q
Farm Name: K 1 � af—j- 2:: Owner Email:
Owner Name: D e1 t-t �� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: -WE> n y, " 2!r ; j AI ; f Title: ,�(,�I / Phone:
OnsiteRepresentative: , ss�-_ Integrator: /y��/,�/�y ancca"_ _
Certified Operator: �j Certification Number: L
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design
Current
Design Curren_-
Design Current
Swine Capacity
Pop.
Wet Poultry. Capacity Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
'= k' g`
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design_ Current
Dry Cow
Farrow to Feeder
Dr. P,oult . Ca aci Po .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
-
Other
ITurkey Poults
Other
1 Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
Callo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
W No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of ins ection: — (o
3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [N No
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): q -,QL L(
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
[:]Yes 0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
g 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
Jallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®, No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E, No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ' ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�
13. Soil Type(s): A 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes g 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 C, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E�] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? []Yes 2 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - p jDate of Inspection: fo-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [SNo ❑ 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
® 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
0 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 GAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®,No
❑ NA
❑ NE
(refer to plain any YES answers and/or any additional recommendations or any other comments,,
lUse dranwm of facility to better exu ain.situatious (use additional oases as necessary).
Reviewer/Inspector Name:
Phone: qly-'41
Reviewer/Inspector Signature:
Page 3 of 3
Date: % /4, 10�14i
21412011

type of visit: WC;ompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: ll¢lsJ» Arrival Time: . p Departure Time: County: Region:
Farm Name: 94 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: _411 j 1}P//11 A: R. ROTE M11 _
Facility Contact: R�?nnl P SM Title: A f4 Phone:
Onsite Representative: Ronne Sm f-i A Integrator: H_R
Certified Operator: Pont) le. S/h 1—h Certification Number: 1 Q3S1
Back-up Operator: p&A &Lb Certification Number: 99 6131—
Location of Farm:
Latitude:
Longitude:
D ig Currpent
'
- = --
Current
Design Cnrrent
Swine Ca aci Po
ryDgn
Wet ontt "'�
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
_
Design
Cnrrent
Dry Cow
Farrow to Feeder
D, .foul
@a aci
P.o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boar;
Pullets
Beef Brood Cow
Turkeys
Outer
Turkey Pouets
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)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ 1�jo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ Yes IN No
[—]Yes j!j No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facifity Number: , $t '�" „ - 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 ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Ig_
Observed Freeboard (in): a� a-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 70 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 [�j 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 C& No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E] No
❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ca No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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): 97r � - sni
13. Soil Type(s): I0fCVVv
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
2g 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? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [] Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis [j 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

Pacility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J@ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes H No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
JK No
❑ NA
❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
tR No
❑ NA
❑ NE
-7. P6e, work sets 41 ol'n a q4d- do s04,e_
f
on �xm Hill Y)e*r J01,2A -e
a� 9
Jp� WOCkIJh, efackr I h V��,
reurdr, alk-
Da '
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�%I,% COW
gi %3-MM t Phone:
Date: U Q d 0 3
21412011

I
Facility No.$ _Farm Name 0(t k Date 6bqtp
Permit COC� OICL NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Li uid Trt. Zone ft
irf
ff
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA7
N3 P-1 _ IP4 iP1
Actual'
Design ■41=i��-----
Soil Test Date
)+.�
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied
Weekly -Freeboard
Mortality Records
Cu-I Zn-I
1 in Inspections
Check Lists
Needs S (5-1<25)
120 min Insp.
1� 1}� Storm Water
IUcarle
1Alnn+i�nr t'nrinc
1
f
MAI
Verify PHONE NUMBEPS and affiliations
Date last WUP FRO 'd'l—qp FRO or Farm Records 30 nQp
Date last WUP at farm Lagoon # i
App. Hardware Top Dike
Stop Pump
Staff Pump 4_9.
7 1q7
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 lblac

J$ /W JVJ. -7100-
■ ype or visit: to t:ompuance inspection V operation mevtew V Ntructure r:valustion V t-echnical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rr� t Arrival Time: " Departure Time: County: _30'" S01
Farm Name: W �Uj e'y 14 a Owner Email:
Owner Name: khl )E! Sjr ! # % Phone:
Mailing Address:
Physical Address:
Facility Contact: Rom,I e �7► ;+h Title: C11-nix Phone:
Onsite Representative: v} d � Integrator: ► I J3
Certified Operator: M C �` Certification Number: 117311
Back-up Operator: Walfp S ;th - Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design Current
DesignCurrent Design Current
Swines=Capacity Pop.
Wet P©ultry Cap city Pap. Cattle Capacity Pop.
Finish
La er Da' Cow
Non -La er Da Calf
Feeder
a
o Finish
_ DairyHeifer
o Wean
rFarrow
z.
-Design``"Current D Cow
o Feedera
aci =P.o Non -Dairy
o Finish
La ers Beef Stocker
Non -La ers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
w
Ot her '
Turkey Poutts
Other T.7 I
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 Ca No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes tS No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit ! Number: 'S- _l jDate of Inspection: 5
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes f—gl'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):'
Observed Freeboard (in):
5. Are there any immediate threats to the integrrity of any of the structures observed? ❑ Yes E:fNo ❑ 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 ff 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 Callo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [RNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �!l No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [allo ❑ NA [:1 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ [] Yes [TNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN 7 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): rQ ��%14 ' '�`r `S IiO/Ol� Q11&S � _
13_ Soil Type(s): / ; Ue_ I
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Co No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 5� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jjjr 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'? If yes, check
❑ Yes
�'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
UNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® 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

• Facilitl• Number: -5i Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,;�'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JR 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail.to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
❑ No
C2-`NA
❑ NE
[:]Yes
[R No
❑ NA
❑ NE
[:]Yes CS -No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes k No ❑ NA ❑ NE
[—]Yes �rNo
❑ Yes 0 No
[:]Yes VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers"and/or'any additional recommendations or any other cotttments�
Use drai3m�s'of facilifv'fo better explain situations (use'iiddttionaltaees as necessarvl.
I S�, so sJ��e j s �'fiur1 , �v [ d 1 i t/e sv1 fw b t lw /�
��1
L Q arts rc r6 r 6!e `�sI Lt e Svrw eK�1 07
s� f '
U6 h.
. po e-wo'� _(
aim re(ord-i 1
K64 �� L'n � ` ''� t✓t3 '
moil ,;1 �% rtih 71s11�.
`k- �� )�dfaf/af6
q� 71r1ra
Lruf �I�� �r �
Reviewer/Inspector Name: t I-nn" Seor _ Phone:
Reviewer/Inspector Signature: T Date: 4�01j
Page 3 of 3 Q 2 4/2011

_71
10,
Facility No. S.L:)360 Farm Name A j Date -1
Permit COC ✓ OIC NPDES(Rainbreaker PLAT Annual Cert Daily Pipe)
i
mat V.^..;
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
r
Liquid Trt_ Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
I%-W—mw:!�
Flow
ActualActual
-
Soil Test Date
�f (I`ilt j
Crop Yield
st')
Transfer Sheets
pH Fields
Wettable Acres
E'If
Q�
RAIN GAUGE
Lime Needed (2_
WUP
"AD
Dead box or incinerator
Lime Applied'
Cu-1 � Zn-I li
G �
Weekly Freeboard
LN
1 in Inspections ✓
Mortality Records
Check Lists
Needs S (S-1<25) IS-X
120 min Insp.
Storm Water
Needs P
Weather Codes
Waste Date
- 60 Da
+ 60 Da
N {Ib/1000 Gal}
I. 1.144
IJY IM
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
'PGr.
a as
SC
ro
'
V rify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at fLagoon #
App. Hardware � � Top Dike 4b.
�? Stop Pumper
Start Pump
IC/(/ qr!
Conversion- Cu-I 3000= 108 Ib/ac; Zn-1 3000= 213 Ib/ac
�orn�efm f�,
c (,,

[Reason
ypr u, visit: rw t-ompuance inspection v uperation rceview CJ arrucrure e,vaivanon V icenmcai Assistance
for Visit: '0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,Q1 Departure Time: ��1r} .� County:_
Farm Name: Owner Email:
Owner Name: 01-)1) l`P_ S� I Phone:
Mailing Address:
Physical Address: 4-771 4err
Facility Contact: ROnn t e- Swith Title:
Onsite Representative:
Certified Operator: nnip Sm j
Region: re
Phone:
Integrator: + f — ,B _
Certification Number: f q3S
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current. *' Design Current
Swine Capacity Pop Wet�Poult .Capacity Pop. -
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Finish
Layer
Wean to Feeder
QQ
1cogo
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
_ Design Current
D , Paul f . , .... 8ci P.o .
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Da'
Beef Stocker
Gilts
Boars
Other
Non -Layers
Beef Feeder
Pullets
Turkeys
jBeef Brood Cow
Turkey Poults
Other
Other
Dischar2es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

r
Facility Number: a - a Q Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):I el
^
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
LQ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 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
C3'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
J'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 Windows ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): Co
R '5�Vll 622CW14
_ L POf-hj/e
De,-n_fd%
�;.�}
13. Soil Type(s): .L lY
i ryV 1
J
1� A L)-B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
`® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
'�T Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J.'2 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? 0 Yes E' No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: a,- a 7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CR No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes C'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes t'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 gNo ❑ 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
6�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
IS No
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other"comments:
Use drawmgs_af:facility; to,.better ex lain, situations use additional a es,as necessa
�r V QAN T- I<[ �C9f� COPr e� �t
+' 4 rw 0—, d 15-hl-7
otc
r,ec d��--%'e�dr 143ad 'Chafe �
Form, %
[M alal node aLvw no`� c� plvd&tt- 6OY71.
Reviewer/Inspector Name
qtf
Reviewer/Inspector Signature:
Page 3 of 3
L
Date: &aa a 0i 1
6011

Facility No.�'a-c�
(aD
Farm Name
l vi1 fi
Date
Permit
COC
OIC
NPDE R r P AT Annual Cert
Pop. Design Current
Type
filfhlr _���
A�ua
.aw, A= s
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
CAbration Date
Design Width
Soil Test Date Wettable Acres RAIN GAUGE
pH Fields 0UP Dead box or incinerator
Lime Needed r��eekly Freeboard Mortality Records
Lime Applied w 1 in Inspections
Cu-I Zn-I 120 min Insp.
Needs P Weather Codes Croo Yield Transfer Sheets Yvili * aQfi 0b. t 6 -7141 /51
60 Day
Cl��r���
-�
., ._'q
F.ifr.W
C .
R�
•
Iasi/-�L�i�r��'�I�►�'
Pull/Field Soil Crop Acres PAN Window Max Rate Max Amt
1 r, 3
Av
Oc
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

Q)fM( 11119116 OV-
��
Type of Visit 15: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: � IIJ GIB, j Arrival Time: Departure Time: County: _1 l7m 011h Region: ERD
Farm Name: n& l 4a Owner Email:
Owner Name: 1r1 P- 1Q J Phone:
Mailing Address:
Physical Address: �
Facility Contact: IZ o f j.p s/b L Title: Phone No:
Onsite Representative: t�l?hl �— S/Y►l4 h Integrator: �+
Certified Operator: �Dnn�Q S/Y11� Operator Certification Number: 19351
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =1 o = I 1=1 W Longitude: 0 ° = ' = u
Current
Design Current
10EDesign Current
JJ'D
Swine
Capaacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
on -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
u
❑ Turkeys
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cowi
Other, :.
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
51No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Q—No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: SX a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ I q iq
Observed Freeboard (in): 3Q(
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [S 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 UNo ❑ 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 E;kNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I No ❑ NA ❑ NE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 19-No ❑ NA ❑ NE
maintenance/improvement? V.
11. Is there evidence of incorrect application? If yes, check the appropriate box below. RYes JENo - ❑ NA ❑ NE
❑ Excessive Ponding � Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L�Qpj}pj h,,,,4n V/)%-brp'
13. Soil type(s) &v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5?No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
CR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ERNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: r ,3�aox._ .,
Reviewer/Inspector Signature: ���, , �.,R,�,A,ri, 9i , .. Date: Nou i1 , aQ 10
Page 2 of 3
12128104 ' Continued

,Facility Number:%G), — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? CjYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check [] Yes J�jNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J2 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 RNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No V 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
Ej�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
El -NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
&rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
'R 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
ffNo
❑ 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
Wo
❑ 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
RrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Rom_
Additional CoEnments an'd/or Drags r` °-
�� ?�PAp we rk or) bGf'-e- s f' 01 +o4,1
pla,) ha_r 1 11 +O-W rf 1 �401
:3 Gm -?Taro c 1 r e A)J W-6' nb e�n
v�l-s ry-� a b- a�� i 7J a� t
clbe��V beb vied I-r
l4 2 I hr i I � said- � 0� CL 'Q f `� , p� �2� P� wl ry" l-fir
C Mai I ek- i Hz-10) `y
Q,r�a j l rv?.Ii mo�h � Via: (n� yooc� i�°cc�rls .
[PdMia�al Ao� o+ 0) rOw� co�y J
9
Page 3 of 3 12128104

. Facility No. 19-*0 Farm Name 04 A419- Date Idol f ®
Permit COC _. OIC NPDES(Rain breaker
FB
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
-Spillway
Design freeboard
Observed freeboard in
J
Sludge Survey Date
Sludge Depth (ft)U
Liquid Trt. Zone ft
3
Ratio Sludge to Treatment Volume
Design Flow
Actual
��i!�------
Design Width
Actual Width
Soil Test Date � 't►" ✓Wettable Acres. i/ • RAIN GAUGE
pH Fields WUP ✓ Dead box or incinerator
Lime Needed Weekly Freeboard Mortality Records •/
Lime Applie445*�Zr, 1 in Inspections
Cu-I n-I 120 min Insp. --7L7-
Needs P Weather Code
CroD Yield Transfer Sheets -, r
sell.
-
.d _
-�
1-17A itiLilliLcf-.I/
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
iAv
4&a
o.s
o.s
All
M
Verify PHONE NUMBERS I and affiliations
Date last WUP FRQ $'�[ f Q6 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Ib/ac
#� D430
App. Hardware

AIMS UV; 10,00q
Division of Water Quality
Faeility Number ®� O T Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 19rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e+Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: '?,S Departure Time: „ County: Region:
PA V
Farm Name: NVl1 t i4 Owner Email:
Owner Name: RDAs 1 e- .� Srrr i;' h Phone:
Mailing Address: 49�Mae A
Physical Address:
Facility Contact:
Onsite Representative::
Certified Operator: Rom I e- S
Back-up Operator:
Title:
Phone No:
Integrator: -Mown
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = O = d = Longitude: ❑ o = , =
is
Design Current
Swine Cap rtyjj P,61 ation�
❑ Wean to Finish
25Wean to Feeder ISQ00
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharees & Stream Impacts
W"Design ! C►urrent
noultrwCapacity P.ODOR 'on
❑ Layer
❑ Non -Layer
I�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle 111110KC-:5Paci Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
t3umber of Structures:
i. Is any discharge observed from any part of the operation?
❑ Yes
[l No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
G No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[9No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: a — o Date of Inspection I
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 Ievel into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I — q
Observed Freeboard (in): -@q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes RNo ❑ 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 [allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
`n No
P�'
❑ NA El 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
1>_� 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 allydraulic 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 off/ Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
�
12. Crop type(s) w� V fnuP� yGojiy r,SOVI1 GI07 ' os ,
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
0No
❑ 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
Comne { q #): Explain any YES answersand/oany recommendattonsorany,other comments.
ferto uestion
Use;grants
vtdngs,0 facility to better explain
situations_ (usetiaddttionai-pagesas necessary:) '
Reviewer/Ins ector Name
p
Phone:
16 433
Reviewer/Inspector Signature:
r Date:
Oct a
, o.
12/28/0
Continued

Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit oMoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ,,u. ID61-6jGT--! Arrival Time: i30 Departure Time: io: County: S S � Region:
p_
Farm Name: �1Y5�4V Y l l -a Owner Email:
Owner Name: AII; P SM 1 Phone:
Mailing Address: TCT- 1 DCK3) ,f it? a8� QOy
Physical Address:
Facility Contact: P-Mnf e S?z do Title: OW4.0- Phone No: — �-
Onsite Representative: Integrator: ' I�
Certified Operator: ROnnie✓ sn I+h Operator Certification Number.- 14351
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = A = d Longitude: = ° =, = u
Design Current ,t Design Current Design Current
Swine )'ACapacity Population�WetPoulltry Capacity Population ... Cattle Capacity Population
..�:_
❑ Wean to Finish
❑ Layer
❑ Non -Layer
DryPottltry:.
❑ Layers
❑ Dairy Cow
❑ Dairy Calf
Wean to Feeder
O
❑ Feeder to Finish
Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑Beef Feeder
El Pullets
❑ Boars
❑ Beef Brood Co
❑Turke s
- {.
Utter '
❑ Other
Numiier of Structures:
❑ Turkey Poults
❑Other
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
❑ Yes
�RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
1 Is there evidence of a past discharge from any part of the operation?
❑ Yes
]@ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number. `a�ol7
Date of Inspection S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;*No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
CRNo
❑ 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
CR No
❑ NA ❑ NE
8. 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
CR"No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CgNo
❑ NA ❑ NE
maintenance/improvement?
I I - Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CR'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 �y❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) .�41_ �llx ✓c�Q_ l f 0.3tVp-e OS
13. Soil type(s)��S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IR No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
C@No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
CRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
C'No
❑ NA
❑ NE
-``y - ..
Comments (refer to'quesfion #)�Explatn`an FYE5 answers nd/or any recommendations or any" oElter comments.
Use drawings of faciu to better�explain,s�tuattons (usekaddEhoaal pages as
A,
Reviewer/]nspector Name � s' Phone: - X333
Reviewer/inspector Signature: Date: a
Page 2 of 3 12128104 Continued

r
Facility Number: <3X aEjlp Date of Inspection
Re uired 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 ORNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. fR'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 [�rNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
E>_�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
WYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
D?NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CRNo
❑ 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
CO 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
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IffNo
❑ NA
❑ NE
Additionalt omments.andlor Drawings:. C'
-
AL
I$. �2eet ��st �'�, , �ia�ln►1� ~>f n �.�,p prel� Safi .
aI, +Pies1, Lje, cq r1 braht vQrve yi�? re(&66
it,
Y+� f-e.Sc� � `i'A1�n - soi �na b
lv o� Y
as, ij0 S t'd s N{ s do � t� �>e w� dale r� li aoo8 t
Good look" - aim .
fD� aW 4 A&-&) fr�m� COrr,
L Ove � dIdt4ab43 fvee4saoa,
Page 3 of 3 12128104

i
Facility Number:49 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
'®'No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
IR No
❑ NA
❑ NE
❑ Yes
Eallo
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No RNA ❑ NE
❑ Yes 597io ❑ NA ❑ NE
❑ Yes EjNo ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
J� No
❑ NA
❑ NE
I, P1$1 Ca 'tr 1[* 1!9. lun 61+P 01:) inth 5 Pr faeoi op 13 58L, go1105 /0 e
' ei9d D v!"�-
f� r
old- d- vvo,k oli3 c X 4eAs r c
�If16- ha-e goaL coves^ro 'Iexe- er no Wems o,) fame ��}���. � _ 1'Pl /� Dkr
L)(fr4�! i
a s [C Vji�-c the In �Vl Sc�M�ICJ eke f Il-) CYr^1i1LI
12/2&04

• Facility No. �a _a Farm Name Ak Date y U `k
Permit COC OIC
NPDES (Rainbreaker PEAT Annual Cert )
Pop.Type Design Current FI:... ��06 H --�
ml6
Desiqn freeboard
Observed ree oard (in)
Sludge Survey Date
Calibration Date
! -.------
Soil Test Date a4lm Wettable Acres Weather Codes
pH Fields WUP - - Transfer Sheets
Lime Needed Weekly Freeboard RAIN GAUGE
Lime Applied Rainfall >1" / Dead box or incinerator
Cu --1Zn 1 in Inspections Mortality Records
Needs P 120 min Inspections
Crop Yield
-AnalysisDate
�il—ifr=
+
w�0'1111
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
3
^ R
0/ J
50
S�
}
l
�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon # Q0
Top Dike 40b
cn;� Stop Pump
L0'06
Start Pump
Approx. Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
App. Hardware

• Facility No. Farm Name k;( Vvri-s Date
Permit COC J OIC_ NPDES (Rainbreaker PLAT Annual Cert )
•.. .- =.
EMMIMMIMMEM
--
--
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge SurveyDate Perm Liquid ft
4 I Is Sludge De th ft
,5
-0. rk n_ r
•f
MR
--®---
Actual Width
Soil Test Date I Ia 0
pH Fields
Lime Needed
Lime Applied
Cu ✓ Zn 1
Needs P n
Crop Yield
Wettable Acres
WUP :�
Weekly Freeboard
Rainfall > 1 "
1 in Inspections
120 min Inspections ,
Weather Codes
Transfer Sheets
RAIN GAUGE
all
Pull/Field Soil Crop RYE PAN Window
wv -a rS'i-5P
v
Verify PHONE NUMBERS and affiliations
Date of last WUP FRO 4ia= Date of last WUP at farm*) App. Hardware Max Rate Max Amt
--l. 17-QL—
Top Dike SD.4D - Ub-W Stop Pump 41ri3 J�}a•C*-145)
Start Pump 4q•WL 411-SQ
h) ,%) 01 %)

Division of Water Quality
Facility Number 2(QQ 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit 40 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ZO09 I Arrival Time. vL Departure Time: I IV; FZ County: Region:
t 1
Farm Name: �'. Owner Email: rye
Owner Name: 1'tY11 Snm Phone: 1D 6 ;__QQr1
2a' IJ
Mailing Address: ��� ! 92"Al
Physical Address:
Facility Contact: TQV\V\ e 5VUL Title:
Onsite Representative:
Certified Operator: ilf
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
No:
Integrator:
'
Operator Certification umber: /9351
Back-up Certification Number:
Latitude: = o ❑ ' = u Longitude: = o = d ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
❑ No
1� NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Cl Yes
No
❑ NA
❑ NE
12128104 Continued

- Facirty Number: qL= Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes A No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
j9NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
u O rp
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 'No
ElNA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes )0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes EdNo
❑ 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 51 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 75 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 n�C"wrop Window f�❑ Eviden
ce of Wind Drift �❑ Application Outside of Area
12_ Crop type(s) k_CO3� &, m4 l-Ya �51�4re). c5m � �tky-, 0
13. Soil type(s)
l
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
1
I�91 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
49 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
f8 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
W No
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature. Date: o'7
I-11"M4 uonunuea

Facility Number: bg, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PQ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 93 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
M No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(3 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
[9No
❑ 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
[P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
El NA
El NE
and report the mortality rates that were higher than normal?
T
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
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 Q Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: j -� Arrival Time: 8 /i1 Departure Time: 09��f Sq County: S'�11 Region:
Pao
T �
Farm Name: wszy s Owner Email:
OwnerName: gon fil e-
Phone:
Mailing Address:
Physical Address:
n— �
Facility Contact: nrtl,o ,5M1 Title: Phone No:
OnsiteRepresentative: PhAVIIIIIStVIII,A Integrator: 9"
Certified Operator: h� Q +A Operator Certification Number: f9I I
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 f = Longitude: = ° 0 1 = u
fDesign
C►urrent
Design Current Design Current
Swine III Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Non -La er
❑ Da Cow
❑Dai Calf
1"" ` -
y
Dry Poultry -
❑Dai Heifer
❑ D Cow
... .
❑ Non -Da
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Turke Pouets
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
"ro—ot
El Other
Number of Structures:
Wean to Feeder
oZfi�
.�-� 0
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
1❑
❑ Gilts
1E] Boars
Discharges &Stream Impacts
. is any discharge observed from any part of the operation?
El Yes
rNo
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
WNA
❑ NE
6. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
(P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
[ZINA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
El Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
I2/2$/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
fPNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
1§6NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): " a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
()9No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
EgNo
❑ 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
[�9No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5No
❑ 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
[ANo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VANo
❑ NA ❑ NE
maintenance/improvement?
] I . Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
4 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > ] 0% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Window El Evidence of Wind Drift Application Outside of Area
12. Crop type(s) _
Crop
�Y W1.6 �ZQ , sr""'� 01
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[K No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(�JNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�bNo
❑ NA
❑ NE
CoVlg". . ... . . . . I . �� ­­`� � N
mments (refer to question #!): Explain any YES answers and/or any recommendations or an3 other comments
Use drawingsF.,6U acility to better explain situations (use.additional pages as necessary.) T
Reviewer/inspector Name— Phone:
Reviewer/inspector Signature: Date: -J96
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 16z' S-fl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F& No ❑ NA ❑ NE
the appropriate box. ❑ WUF ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ER 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
'D No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[H 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
EE�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W 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
N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1�1No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
91 No
❑ NA
❑ NE
Additional Co' nments and/or Drawings: ... :
Page 3 of 3 12128104

O'DiAsion of Water Quality
EactlifyNumber ?dZJ
0 Division of Soil and Water Conservation k
0 Other Agencys�
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: '7"/'OS Arrival Time: Departure Time: Count}: Region: 12 o
Farm Name: —�aa Nu.se T 1 0.w Owner Email:
Owner Name: �� ,'t .i,., ; f� Phone:
,Mailing Address: `� C .;{��83 2 R
Physical Address:
Facility Contact: IG'A A- ,<,, ,14 Title:
Phone No: 9/0 - 3 1 -9_2 9 y
Onsite Representative: AQ.,,,,:�,��.z�j _ Integrator: 11v,r��%���er.�
Certified Operator:ene�e_ S Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
mean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o ❑ I = Longitude: ❑ o ❑ ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
E2 L2Q 2&, ❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non-Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
c. What is the.estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge by 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 9-1Co ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
El NA
El NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes 9-no ❑ NA ❑ NE
2 ❑Yes o ❑NA ❑NE
12128104 Continued

Facility Number: �b O Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[q<
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure.] Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: _ t
Spillway?: no �o
Designed Freeboard (in): r
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L_K
❑ 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*<o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3<o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
rM-Ko
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[t�o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PTo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EH o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
.7-1f ro
12. Crop type(s) v G
13. Soil type(s) 14,
14. Do the receiving crops differ from those designated in the CAWM P? ❑ Yes UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes QoNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ,❑ Yes ❑ No ❑ NA a4gE
17. Does the facility lack adequate acreage for land application? ❑ Yes El No El[E NA NE
18. Is there a lack of properly operating waste application equipment? El_S TYes LoNo❑ NA ❑ NE
Reviewer/Inspector Name �j�J K �g t� �� _ Phone: q10-4f - /Sy/e,d �3a
Reviewer/lnspector Signature: Date: 7-/-or'
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Quo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [;3K0 ❑ NA ❑ NE
the approprrate box. ❑ ? ❑ Chec isT ❑ Dew ❑ Ma;a— ❑
21. Does record keeping need improvement? If yes, check the appropriate box below, es ❑ No ❑ NA ❑ NE
❑ R�€a� ❑§teslti�rg [9<r"op Yield ❑ 1 s ❑ ❑ Vtt'eart}rer-Eedei
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
9—No—
❑ NA
❑ NE
❑ Yes
UW
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
2-Nf
❑ Yes
❑ No
❑ NA
9-IqV
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
�E
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
2NO
❑ NA
❑ NE
❑ Yes
❑ NA
El NE
❑ Yes
,ENo
LI No
❑ NA
❑ NE
El Yes
Q' o
❑NA
❑NE
❑ Yes
[3 o
❑ NA
❑ NE
Adtl�honal Comments and/or.Drawings
14r
nS re co /'0/5,
Mrs ,Sut;T11 Ght,aic4fl /'B.ne
i ce( « c�ora �r� ��.�,, /or r eId 7V;S
Mr Sn,,'�1t Ao Aloe
Yea- s "-er•'�G/A C r0�0.
12128104

of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Ieason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: !O' 8' Tune: : s o
LL 0 Not rational 0 Below Threshold
Qfermitted ['Certified 13 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: -2 County:
Owner Name: , , • onn 1 e S�n� 'Phone No: 910-4sy2-142-1y3­
Mading Address: ___'122.__ !tllaae. Z . /L ✓ t-G 4", o.ti / C_ ' ,C
Facxlit-v Contact: RAns�� s�� . Title: Phone No:
Onsite Representative: Res- -- -.,th Integrator:.eMY.[e .
Certified Operator. /dan a I S Operator Certification Number:
Location of Farm:
Ebwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• 0' Du
e.CPra eat = ' Desaga Cnrz ent Current
-.
Swine v. Povalation.P'3! . : Caetaci#v Poisulatiaa. " CatBe Ca>;aadv:" Pvmulation.
can to Feeder9,200
b O
eder to Finish
rrow to Wean
r
rrowtoFeeder
rrow to Finish
lts
Boars
Total Design tY `
Total S§J,
I?isrt,a .xes & Stream.hovacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes Jallo
❑ Yes DIF0
0-yes Bwo—
❑ Yes EkNo
❑ Yes [zM
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [}No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ETNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3 G
12112103 Con inued

Faciiity Number: 8.2
Date of Inspection O
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ENo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2fio
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance improvement? ❑ Yes Gjf4o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Gl'i o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [iio
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes GI-14o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 04o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
.ass So
12. Crap type IBt��� -sue.// G. s 4l1....../
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ['io
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.
Reviewer/Inspector Name � ry
1
Reviewer/inspector Signature:
Date:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes EKo
❑ Yes �o
❑ Yes ❑ No
❑ Yes ❑44
❑ Yes Bigo-
❑ Yes ®-Na
❑ Final Notes
12112403 c:onunusa

Facility Number: $? - ?� o Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑-Id'
22. Does the facility fail to have all com nents of the Certified Animal Waste Management Plan readily available?
(ie! �"' ch, d,�, etcetc.) ❑Yes ❑-Nff
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ bra m ❑�' ❑ his g
7 -/� 2 .0" 3, 0 3- /
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes M—No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes DKO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problem, over application) ❑ Yes P No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 9.90
28. Does facility require a follow-up visit by same agency? ❑ Yes 2�o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? [:]Yes GM
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes Q-No'
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
.12112103

- •--- _.----_____.— w_..._._._ ..�-�._—_�_._ -_------------- ----------•-----taCtllty N�bsr.�-�n
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:
r66 /1-91&
'rIZlG: 8
Dneral Information:
Farm Name:
Owner Name: �� _ �►� phone No: S
On Site Representative: Integrator:
Marling Address: *-
Physical Addres&I ocation:_ © 5 it. _
Latitude: I 1 Lon 'lode: I I
Operation Description: (based on design charactaisda)
ij+pe of Swine No. of MimaLs ?ype of Poalrry No. aflhiinals Type of Catr4 xo. af.�sima[s
o sow a Layer a Dairy
GMVIWY. t t7o 0 Nan-Lryrs 0 Beef
a reach
otherrype of liwi ock xamber of Animals:
Number of Lagoaas _ (include in the Drawings and Observations the freeboard of each lagoon)
Facility JnsRggfio•
Lagoon
Is lagoon(s) fiwboard less than 1-foot + 25 year 24 hour storm storage?: Yes 0 NoJ!
Is seepage observed from the, lagoon?: Yes 0 No
{/
Is erosion observed?: Yes 0 N%
Is any discharge observed? Yes D Nq6
0 Manmade Q Not Man-made
Cover Crop
Does the facility need more acreage for spraying?: Yes ❑ No
Rocs the cover crop need improvenm 7: Yes O . No
(fist the crops which need bVro► enwnt)
Ckop type: Acreage: ?
Setback Criteria
Is a dwelling located within 200 feet of waste application? Yes ❑ No
Is a well located within 100 feet of waste application? Yes 0 N
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream? Yes 0 No R
'Is animal waste land applied of spray irrigated within 25 feet of Blue Line Stream? Yes ❑ Nogf
ADI — Jam" 190%

Alaurte.- -cc
Does the facility mawtenaaae nerd impmvemeat? Yes O No
Is there evidence of past discharge from any part of the operation? Yes 0 No
Does record keeping need improvr,.meat? Yes O No
+r• Did the facility fail to have a copy of the Anirnat Waste Management Plan on si00 Yes O No
Explain any Yes answema-,
Dale: �o l
cr FMOry Assessmew Unix Use Amm menu #Needed
�q 4
Fme-boc..r-1 y s-`
. ... .. � ww+r.�. —w. �=wi r �. w�" ��Y Ain+rA •.•waM�r+!"�••►.=.�� .~..e'-
.�. .. .— _ • �.� .ram.-•—
• "!Y.-w-.i: rri.w ,f.w..- 'w •�..� I�i:� .f:. -t.y. L.��.•+r�.��rw � �� -
AOI- Januar717.19%

er
RECEIVED 7
i���� HS
��
JUL 0 5 2012 Animal Waste Management System Operator Designation Form
CENR-FAYETTEMLLE REGIONAL CFACE
Facility/Farm Name:
WPCSOCC
NCAC 15A 8F .0201
Permit #: Facility ID#: �- aW County:
Operator In Charge (OTC)
Name:
First
Cert Type / Number:
Signature:
Middle last Jr, Sr, etc.
Work Phone: ( )
Date:
" I certify that I agree to my designation as the Operator in Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
Back-up Operator In Charge (Back-up OIC) (Optional)
(�}
First Middle
, A Last Jr. Sr, etc. ? Q
Cert Type / Number: _ f*�VA qU9 3 S— Work Phone: (q 10
Signature:_ Date:
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Owner/Permittee Name:
Phone #: 7f '-S Fax#: ( }
Signature: D
(Owner or authorized agent)
Plewe- mat oar -�
Mail or fax to: WPCSOCC
1618 Mail Service Center +f
Raleigh, N.C. 27699-1618 14' •r Joa-7
Fax: [phone] �-�� 7 i
aa-Cq/��a s�V
(Retain a copy of this form for your records) R( }�(`J i( ^"�l J le Pe a 6 30
Revised 8l3(iQ7 (