820269_INSPECTIONS_20171231

NURTH CAROLiNA
Department of Environmental Qual

F
a�r�s rN rn�y �g t�
Type of Visit: OTomp ance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: oufine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: /It Departure Timer County: A afl) Region: 1�2D
Farm Name: EE) -,14, Owner Email:
Owner Name: dCfd-8'n rwc Phone:
Mailing Address:
Physical Address:
Facility Contact: ] r� 15 L'3"Vy'U trA Title:
Onsite Representative: l
Certified Operator: 4W4tt0�4:!!it I baec)y-'
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator: M
Certification Number: If 37
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Currettt
Capacity Pop.
O
Wet PoItRy1c.apaclty
[Layer
Non -La er
Design
Current
Pop.
Design Current
Cattle Capacity Pap.
Da' Cow
Da Calf
Feeder to Finish
Design Current
D : Paul Ca aci Pit
Dai Heifer
Farrow to Wean
Farrow to Feeder
Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
;,. ....
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 ❑-ITo—❑ NA ❑ NE
[-]Yes
[:]No
[]-NA
❑ NE
❑ Yes
❑ No
�
❑ NE
[:]Yes [:)No
❑ Yes ❑moo
❑ Yes E7 No
E3 A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2015 Continued

F'acili Number: - Date of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[a.NLm--_❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 3 t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3—Ne- ❑ 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
[ro ❑ 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
� ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g-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
ED-No ❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�J� ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E]' I�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C9 U 56 '0
13. Soil Type(s): G4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 02-fl4o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [IlIo ❑ NA ❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application? ti
❑ Yes
❑moo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Ig"1""
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M-1 00
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�No
0 NA
❑ NE
the appropriate box.
❑WLTP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes
E3<o
❑ NA
❑ NE
❑
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑
Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
En No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: kZ - Z 6 Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [i;].].►Fo~ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E,.NT ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes En -No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑-K-o ❑ NA ❑ NE
❑ Yes O-o ❑ NA ❑ NE
D Yes [E o'o ❑ NA ❑ NE
[:]Yes F9" o ❑ NA ❑ NE
[:]Yes
No
❑ Yes
[ o
❑ Yes
Q_ e
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Ca<<b V-4. (D-1 -- 9 -1 s-l6
(;lj7 ll- i-7
C'
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Phonegl Q-- q1 3 3-3 J 1 t�
Date:
21412 b 15

t Fr a _ V
_ "��" ` i`vi'sion of Water Resources
_Facility Number � - ��„ � Division of Soil and Water Conservation
_ QQ Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:Fj I s' Departure Time: '"SS County: J
Farm Name: EK_ 6� Owner Email:
61
Owner Name: ( �'4 IPhone:
,Mailing Address:
Physical Address:
Facility Contact: Q-4.415 64u-w (GAl"' Title:
Onsite Representative: 11
Certified Operator: & L,
Back-up Operator:
Phone:
Region: Pzz
zz
Integrator:, `s
Certification Number: � fz:g 7-V
Certification Number:
Location of Farm: Latitude: Longitude:
.= Design Cnrrenf-� Design Current Design Current
SwinVe-
ILI Ca aci Po '`N'ePo Capacity Pap.Cattle Capacity Pop.
VFinish La er K Dai Cow
Finish Dai Calf
Feeder Non La er �Dai Heifer
o Weanesign Current D Cow
o Feeder �D PoulteCa aci -Po Non-Daio Finish La ers Beef Stocker
Non -La ers Beef Feeder
of Brood Cow
-..
TurkePullety s Beef ,
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes C 1 -o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E35NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
0A
❑ 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
ff NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: 7_3 N
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg1V6
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
D'1'A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):2—�.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ 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
[DNA
❑ 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
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydradlic 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): CS S(; O
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETNo ❑ 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?
Required Records & Documents
❑ Yes RNo ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes el
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes. check ❑ Yes [l/ 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 [2'&o ❑ 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 tail to install and maintain a rain gauge? ❑ Yes EXNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi , Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes a' o ❑ NA ❑ NE
25_ is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ ]Ko ❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F3/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than nonnal?
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
g(No
❑ NA
❑ NE
❑ Yes
4No
❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[]Yes [�No ❑ NA ❑ NE
❑ Yes � o
❑ Yes ff l o
[]Yes YNO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Cal t`b q-fS l b
� c
Goo- Or -
Off'-
Re
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 1V 0 3. 3 J
Date: ..5 x
2141201

%Iwl� 3o zvm- 16
Type of Visit: (fCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 0rRoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access II
Date of Visit: Arrival Time: j d Departure Time County: j�{ Region:
L�
Farm Name: Owner Email:
Owner Name* ^ �,M �G�i�jr.s l,�ione:
Mailing Address:
Physical Address:
Facility Contact: if as �ZJLY/t Title: Phone:
Onsite Representative: l Integrator:
Certified Operator: "'064C Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Cattie
Design Current
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I INon-Layer
I
airy Calf
Design Current
D t P,oul @a aci P,a
Layers
airy Heifer
DrvCow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other"�`
. sue.
Other
Pullets
Turkeys
TurkeyPoults
Other
Beef Brood Cow
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?
Page 1 of 3
❑ Yes C21 ❑ NA ❑ NE
❑ Yes ❑ No [ A ❑ NE
❑ Yes ❑ No i [1. "IQA ❑ NE
[:]Yes ❑ No ❑'NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No []' 4A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IB, 11Oto
❑ 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
[T 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
20
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E5No
❑ 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
Flo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑'�lo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
/
12. Crop TYpe(s): 6--6 S (' D 914" -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�'�io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [B'N' o [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [E]No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[3 o
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 <o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [►rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I?acili Number: RZ - I & jDate of Inspection: U
cA.&
24..Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[! 'l10 ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑'<o ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[�Ko ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ❑'1 f�o ❑ NA ❑ NE
❑ Yes ❑'1CIo ❑ NA ❑ NE
❑ Yes r__A'! o ❑ NA ❑ NE
❑ Yes T o ❑ NA ❑ NE
❑ Yes Rio
❑ Yes 0No
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or: -any ather`eomments r
Use drawings of facility to better explain situations {use additional pages as necessary).
4 0-1 q - {
S(u�jt qej--j 5
q 6
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: cm � 3 L
Date: saml
2/4/20l l

lype of visit: V Uommpliance Inspection U Uperation Review U Structure Evaluation U I ectinical Assistance I
Reason for Visit: E Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:9;A:19 rrival Time: e n Departure Time: i 5 County: Region: ffa
Farm Name: i) V Owner Email:
Owner Name: �s r t,. - 5, 161r Phone:
T"
Mailing Address:
Physical Address: Q
Facility Contact: l;n �cLA4Xs Title: Phone:
Onsite Representative:
1(
Certified Operator: tr
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
'�
D
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Discharges and Stream Imoacts
Nan-L
Pullets
Other
Latitude:
Poults
Integrator: r `�3
Certification Number: ' 3 G t/
Certification Number:
Longitude:
Cy ow
Cy alf
Hy eifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes E 'Ko— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes ❑ No ❑' 114A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) []Yes 0 No ETNA ❑ 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)
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 r❑ 0
❑ Yes G3'No
[3lA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

FacilityNumber: Date of Inspection:
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
Identifier:
[tj. ❑ NA ❑ NE
❑ No ff t-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �s Z
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes O `o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ql�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q-<
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
r,-9'fTTo
❑ 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
[� o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E),Xo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ o 0 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):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Uro ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FI No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [J'&o ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yesro ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [D No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [] 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 ❑.l�o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C: o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r240
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [-]Yes [3,N6
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I- ,Ko
❑NA ❑NE
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
C - o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑'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
Io
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[-]Yes
O No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
fNNo
❑ NA
❑ NE
Comments (refer to question ft ain any recommendations or any other com cents y � ,
tuations
Use drawings of facdlty-to better explain (use additional'•pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I�, I� -[q -#I, 0-q,,7
P-3, -s ifz - Z'
3,f ��top
ry
1] t u Phone: L3— O
c
Date: .31
21412014

Type of Visit: WCompli
CJ ✓ance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
r .�
Date of Visit:IT _tZ_ Arrival Time:�/J i JV I Departure Time: County: Region
Farm Name: G Kj i Owner Email:
/J r
Owner Name: �QU�CP�VIA� —z?V!%f Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 4
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: IdRIZAD
Certification Number:
Longitude:
'.
gn Current;" _._
Design
Current
Design Current
SwinejMCffiap
city P pPoultry
�.
_ Capacity
Pop :_
Cattle Capacity Pap.
_.:
Finish Layer
Da' Cow
Feeder
­ij
.."- Non -La er
Da Calf
o Finish
Da Heifer
EFeedert,
o Wean "` Design Curr of `
D Cow
o Feeder
"_D�Poplt
Ca acity�.
�1Po
Non -Dairy
o Finish
La ers
Beef Stocker
M Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
= TurkeyPoults
Other
Other
Discharses and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes L_4�'m lI NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [� ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No 0_bLA ❑ 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)
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 ®.Pd1(_ ❑ NE
❑ Yes [ZL>o" ❑ NA ❑ NE
❑ Yes [;J-N'o- ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: out] 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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ 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 [] 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):
13. Soil Type(s): W C"
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No D. 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes [:]No
23. If selected, did the facility fail to install and maintain rainbreaker: on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDatc of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1 " ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No iA ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes l; ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes Eq4o ❑ 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 ]Vo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
<o
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 10 ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [;6o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ENo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes D(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, other comments �. :.
Use:drawings of facility to better explain situations (use additional pages as necessary).
_
Czb4\ _00 --• �- �S —CZ
elf�4 — 3, (
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
PI6! -1
Date3b Lt'
Page 3 of 3 21412011

I
Type of Visit: &Compliance Inspection U Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: {Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1-1 a5 Arrival Time: S ` Departure Time: Courtly: m ,� Region: Oe
Farm Name: r
{ hnR nnUn Z —ThOR1iT6/1J )� ). C Owner Email:
Owner Name: 7hoRni'1-on Q %j,oQg'Tort7 Phone:
Mailing Address:
Phvsical Address:
Facility Contact: q Title: Phone:
Onsite Representative: C iepn.F_ Integrator:
Certified Operator: ( (Rpm$ -T�tQfknko tD Certification Number: 167� 1
_i.._,
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design C•ur:rent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
- Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
� -
Dry Poultry
I
Design
Ca act_ty
" '
Current,.
P,o
airy Calf
DairyHeifer
Dry Cow
Non -Dairy
Feeder to Finish
• pay
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Pther
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
ffNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[DNA
❑ NE
b. Did the discharge reach waters of the State? (If yes.. notify DWQ)
❑ Yes
❑ No
[3"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
[�rNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[D'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Conhinued

lFacility Number: a - a 1<5 Date of Inspection: a
a -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[TNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No
[U$4A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: AA
Spillway?:
Designed Freeboard (in): !c% %Cj
Observed Freeboard (in): ZL_ ot"1
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
dNo
❑ 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
ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ NA
D. NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes v❑rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [v No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
k,
12. Crop Type(s): Q?Rtr�u y Q Ya H }
13. Soil Type(s): L3 pA Np� [r
v
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
[gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
[ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
[3/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
[DNo
❑ 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
ER/No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
D/No
❑ NA
❑ NE
Page 2 of 3 214.12011 Continued

Facifi Number: 2JA - Date of Ins eetion: 24
Ia
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ffNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[B"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
ff No
[DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[DNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [yNo ❑ NA ❑ NE
0 Yes [jrNo ❑ NA ❑ NE
❑ Yes [�No [DNA ❑ NE
❑ Yes 53�No ❑ NA ❑ NE
❑ Yes [�No
❑ Yes RNo
❑ Yes WNO
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: s 2'
Page 3 of 3 2/4/2011

Type of Visit: Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L'l� Arrival Time: 3 d 1 DepartureTime: / County:
Farm Name: /' jj_ x— t- 7 jnl-nd`ri LL e- Owner Email:
Owner Name: �d i7` 7;T�rt.O,�_P— / L Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ��,�
Certified Operator:
Back-up Operator:
Location of Farm:
/`07 = • // /pvi. Title: W )7 e-r
Integrator: %% LI*_
Certification Number:
Region:
Latitude:
Phone:
Certification Number:
Longitude:
Design; Current Design Current Design Current
Swine 'Capacity Pop. Y x Wet Poultry Capacity Pop. Cattle Capacity Pop.
m
Finish
Layer
Dai Cow
Feeder
o Finish
o Wean
o Feeder
U
aD
3 AID
K=
Non -La er Dai Calf
Dai Heifer
Design Current D Cow
D . P,oultr, Ca aci P,o Non -Dairy
La ers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Turkeys -._.
TurkeyPoults
Other
oFinish
E=Oit
-,,
her
her
Z---
Discharizes 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 [RNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )No
❑ Yes JR1 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page l of 3 21412011 Continued

Facili Number: - Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® 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): 3rp
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
allo
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EL 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
E;,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Jallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /��T/1?kdcc �dOiJzarSx-�� __
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Na No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CA No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JZ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - A jDate of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 JR 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
[a 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
®No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
fo No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
gj No
❑ NA
❑ NE
Comments (refer twquestion ft Explain any YES'answers and/or any additional recommendations or any other comments.
lUseArawings of facility to better explain situations (use additional pales as necessary).. . `
�..
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: Z2 a
21412011

3
Type of Visit (ZVtompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: — (L Arrival Time: Departure Time: c3 �. County Region: F5;LID
Farm Name: � s 4 �; r aoLl I Owner Email:
Owner Name: a -a ,l"!-off s _ Phone:
Mailing Address:
Physical Address:
Facility Contact: L. ra / +`r_ f D 6S Title: 1'X� r�� Phone No: k9.33
Onsite Representative: r s--,'/` %Y%t?�f-� _ _ Integrator:'
Certified Operator: t�n t2.r »ra��rr.� — Operator Certification Number: ! gl q
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = 11
Longitude: = o = S ="
Design Current Design
Current Design Current
Swine Capacity Population Wet Poultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
Feeder to Finish
s
❑ Dairy heifer
❑ Farrow to Wean
pry poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
No
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: Date of Inspection / O — -Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ 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): Z 40
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EK 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 ® 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? aYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [9No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes rOl 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 P9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or I0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)�
13. Soil type(s)
V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®-No
❑ NA
[:I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JR] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
r"A No
❑ NA
❑ NE
IT 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
QNo
El NA
El NE
Reviewer/Inspector Name y�7��� Phone:
Reviewer/Inspector Signature: Date: /p �Z} d/'q
Page 2 of 3 121zZ 04 Lonttnuea

Facility Number: — g Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 59.No ❑ NA ❑ NE
the appropriate box. ❑ W-Up ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U4,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 [KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JKNo ❑ 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
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RTo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J4No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[KNo
❑ 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
E�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P9,No
❑ NA
❑ NE
Additional`Comaients and/or `Drawings: ml
Page 3 of 3 12128104

&Z14 t S i 2" - 6 4 -2_ov 9 4e41-Z —
Type of Visit &6ommppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (7 koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % Sr Departure Time: County: Region: '�2O
Farm Name: L �51; f%�,/.S f�v;�.. ( =v,�;�.:,; 12 v—) Owner Email:
Owner Name: ��Sh c-�� s Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 me r Title: Phone No:
OnsiteRepresentative: C-rc-Y' Mcr-y-L Integrator:
c"�6 7�,� .v i -7 9/ 9
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = l =" Longitude: =o = d
Design Current
Design C►urrent
Design Current
Swine Capacity Population
Wet Poultry C*apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish 'SZO .ZJrC%
❑Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Nan -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
the
❑ Other
❑ Turkey Points
❑Other
Number of Structures:
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes B 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
DNA
❑ 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
r�,�
t� wA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[-To
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number:8�
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 t Structure 2/ Structure 3 Structure 4
Identifier: G,,L4N5 / �CId > '-"�1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -• 7 33
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes El"No ❑ NA ❑ NE
❑ Yes B<o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Bl 10 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Bl�o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2&o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement?
1 l .
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Efo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12.
Crop type(s) &n.. c / ifk�) S •H a!/ � r r iy 60 . S.
13.
Soil type(s) i Jo,.- g
t4.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
,�--,,��
L�71vo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
21�o
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
❑•o
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
E <
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA ❑ NE
Reviewer/Ins ectorName
p Phone: /a, �f 3f • 3 o i
Reviewer/Inspector Signature: m Date: 1,2 -,4 b'"`200
12128104 Continued

Facility Number: 2 — Date of Inspection %z-og-vq
Re(juired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes HKo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 o ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L`_7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E,'�Io
El NA-
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
E o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
©'iTo-
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[jj<
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9-96-
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ yes
E4<6o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
1 v
El©'NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B o
❑ 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
E o
❑ 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? (id discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
[I NE
33. Does facility require a follow-up visit by same agency?
El Yes
,,��,,
L"No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

✓ n,s j-08 -09 R-R—
Diviision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit 8"Lfompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IZ /y-O 8 Arrival Time: Departure Time: /,• O �.. County: lol—of?XVAI Region: `IW
Farm Name: _1 esh't-- W_/p6s Y►'�-- - Owner Email:
Owner Name: Lt5/i C_ Akle-S Phone:
Mailing Address:
Physical Address:
r~e- c.v Al co+r'� r1 .
Facility Contact: � Title:
`-c- Phone No:
Onsite Representative: t 4 me_-r 9",- A— I Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ='
=' Longitude: = o =' = s
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
10 Wean to Finish
❑ Wean to Feeder
®'Feeder to Finish ZSZa
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑_ Other
❑ Layer
❑ Non -Laver
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current_
Capacity Population;;_.
t
❑ Daia Cow
❑ DaiEX Calf
❑ DaiEX Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Beef Feeder
❑ Beef Brood Cowl
i
Number of Structures: F7z
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
at
❑ Yes D<o ❑ NA ❑ NE
❑ Yes
❑ No
3NA
❑ NE
❑ Yes
❑ No
DiA
❑ NE
[INA
❑ NE
❑ Yes
❑ No
❑ Yes
[�r`No
❑ NA
❑ NE
❑ Yes
Bto
❑ NA
❑ NE
12128104 Continued

Facility Number: ff2-2- 67 Date of Inspection /z-t7-OS
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? ElYes LT No ❑ NA ❑ NE
Structure� / Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4,2 - 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 27 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ld No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.) �,�
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes k1 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 thr t, 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 L7 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 Cl/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1_'T1vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window }❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) 18erM44c1
13. Soil type(s) % O--R
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes io ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑']moo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name , e_ du Phone:
Reviewer/Inspector Signature: Date: /2-/7-Zm
I2128104 Continued

Facility Number: SZ -- Date of Inspection
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑- o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 3No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P o ❑ 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 G-110 ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [4-ilo� ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C -Xc,
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B5a_
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2 iGo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C}io❑
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DiTo-_
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Er5o
❑ 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
0`9o'
❑ 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
2<
❑ 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
3<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
vivo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit QC4edffiipliance Inspection O Operation Review O structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint Q Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: I Z��Arrival Time: � Departure Time: I 11PLT0 I CountyRegion: 0 /? �
Farm Name: �S l�` t//C &M&!5 h // �� // ✓•yam Owner Email:
fO
Owner Name: L >o �L i G 's Phone: 9 f
Mailing Address:
Physical Address:
Facility Contact: rif AD6�S Title: Phone No:
Onsite Representative: o! Integrator:
Certified Operator: zgnoA.. D/? D'Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 4 [= Longitude: = ° = S = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I_ ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cu
Cattle Capacity Popu
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
fZNo
❑ NA
❑ NE
12128104 Continued

:71 Facility Number: Date of Inspection %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;K 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?:
q
Designed Freeboard (in): / 14
Observed Freeboard (in): ag
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
N No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
N No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
9No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect 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 Drill ❑ Application Outside of Area
12. Crop type(s) a /— r- A,
13. Soil type(s) Uja
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,Q No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
[WNo
❑ 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
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
cps f
_r17
rV
Reviewerllnspector Name - Y Phone: `}/0-eI33 33 aci
Reviewer/Inspector Signature: Date: ,i�X—
»rnAins I�ilNNHf/O/I

Facility Number: — Date of Inspection —3►— 7
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? BYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Lo Yes ® No ❑ NA ❑ NE
❑ Waste Application M Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
® Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections El 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?
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
OR No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes IM No ❑ NA ❑ NE
❑ Yes 5? No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
E
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit• / 20 Arrival Time: OB-2SgM Departure Time: p8: S�q, M County: 15+_M�A1Region: 4
Farm Name: _ Lee, Ct f- 11,9AA-S rn — Owner Email:
Owner Name: besPe dO4 Phone:
Mailing Address:
Physicat-4ddrcss
Facility Contact: Pona l WeS &l_ Title: Phone No:
Onsite Representative: Integrator: i'ylwr'P
tr Certified Operator: Operator Certification Number: PSAg19
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 , = Longitude: 0 o 0' = u
Design C*urrent
Design
Retoultry
Current
Design Current
Swine "e_ Capacity Population
Capacity
Populaan
Cattle Capacity Populatian
❑ Wean to Finish
10 Layer
❑Dai Cow .
❑ Wean to FeederIIIE]
Non -Layer
iry Calf
Feeder to Finish
❑Dairy heifer
❑ Farrow to Wean
Dry Poultry
E]Dry Cow
❑ Farrow to Feeder`
ElNon-Dairy
El Farrow to Finish
❑ La ers
El Stocker
❑ Gilts
Non -Layers
�;jl Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
'�
❑ Turkeys
Other
❑ Other"
❑ Turkey Poults
El Other
Humber of`Struetures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
[ANA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
F 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?
Page I of 3
12128104
Continued

G
Date of Inspection ►I �(�gl,�_
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
r No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
F9 NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
fI
Identifier: — (olq L11
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3VO
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
ElNA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
V3 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
M No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [0No ❑ 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 C9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EN No ❑ NA ❑ NE
❑ Excessive Ponding ❑ 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 Area
12. Crop type(s) LO'Qs4m(Ter wvAJa 6,aSs mat. ) , SMQ 11 Cw l;.
13. Soil type(s) Woo ya im r
V
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5 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
V1 No
❑ NA
❑ NE
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`?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or: any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): r Y"
Reviewer/Inspector Name Or�j[e Phon /D 53 60
Reviewer/Inspector Signature: Date: ?L
Peon 2 of 7212 104 Continued

Facility Number: Date of Inspection
Required Records & Documents r ,
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ,N No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JQ 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 Reviewerllnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
V1 No
❑ NA
❑ NE
❑ Yes
[$3 No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes IM No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes "dNo El NA ❑ NE
❑ Yes [7No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
S. w� c ql rec#45
Page 3 of 3 12128104

. Division of Water Quality
FaciLty:Number �.z --2 (, 0 Division of Soil and Water Conservation y?-
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `//- Arrival Timer Departure Time: County: S4:j e.&ej Region:
Farm Name: Le_ 1,', &Ac far,, Owner Email:
Owner Name: Zedie t"'S / Phone: 7/O -_ 533- 39"
Mailing Address: 90�;, C-LmV,.;?832$
Phvsical Address:
Facility Contact: eon o G Title: Phone No: at O - S-7 o- L / q,9
Onsite Representative: 1"e- Integrator:
Certified Operator:-Qctezl*.e — _OTyf :�� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o Longitude: 0 0 ❑ ❑ u
Swine
Wean to Finish
Wean to Feeder
g'eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La yet
Other
❑ Other -- _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made.'
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures,
�h
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Q'1 0_ ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�No
[INA
El NE
Yes
El,
o"o
❑ NA
❑ NE
12128104 Continued

Facility Number: —.26 dy
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 9To
❑ 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?: An n
Designed Freeboard (in): dl
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes gfqO
❑ 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 [-io
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Q 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
9 r4o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
g No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
3 S` 9' o
12. Crop type(s) 6era, 'j 5-7a // 6 r, .:g
13. Soil type(s) f,JQB
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[�JNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9-No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA D414E,
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA []09E
18. Is there a lack of properly operating waste application equipment? ❑ Yes
91eo
❑ NA ❑ NE
Reviewerllnspector Name L r /►Tar/f , :Q r Phone: O- -ISVr/30
Reviewer/Inspector Signature: Date: 7-/70,q--
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ R Yes o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
[91es
❑ No
❑ NA
❑ NE
the appropirate box. ❑ W ❑ Che sts esign ❑ MO �s ❑ Oer
21.
Does record keeping need improvement? If yes, check the a propriate box below.
4-. � X 3 1 •10-� .a -1,. 7, 7
9 es
❑ No
[I NA
El NE
?.
El Waste Appliea6on ❑ El❑ Soil Analysis ❑ *ia
ans
E]Rttinfitll ❑.Steek nr 9'6rop Yield ❑ 1
�,ss
El
W�eathd
Bade
22.
Did the facility fail to install and maintain a rain gauge?
El Yes .
[:1 NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,L�y,1Vo
L1"❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q Ko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El<oo
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
g-gE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [- -<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
d?'O
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9To
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32, Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E*o'
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[ Io
❑ NA
❑ NE
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l2/2&04

(Type of Visit &C=outine
nspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: D t Tune: � �D�
Facility Number �
Q Not rational O Below Threshold
"e tted Eltertified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ........
Farm Name
W 1 b __... ... __........ .. County: _.....
Owner Name: La Phone No:
Mailing Address: ..!!°` ... i!Gv i.. f`� .._...._.... .�----L.l ivl`�os. �C 3 �8
n.........................._............�............................. ..........»...............
Facility Contact: ..._L_ b.
Onsite Representative:..
Certified Operator:.....
Location of Farm:
Title:
-- — one No:
Integrator:...._....... r,r�. - ......�. _ _..
Operator Certification Number:_---_---_
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �
Discharges & Stream Impacts
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 gal/rnin'?
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 ❑
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes B— e
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑-Pk�
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B_No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier- ............ _..................... ...................... - ... ...._...... --........... .............
Freeboard (inches):
12112103 Continued

Facility umber: .1 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
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!unprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement? 44-t A01r)
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 attor 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.
VL✓� o� t444v— tvv r TS y1V+ a 5 )Wo aS00-11 *Srj `{ h rno5t a
_ f Y�
6-%A 1 ar, &--,.S `
Reviewer/Inspector Name
Reviewer/bmpector Signature:
12112103
❑ Yes No
❑ Yes 04-o
❑ Yes
❑ Yes QNw_�
❑ Yes
❑ Yes
❑ Yes
&Ko-_�
L rvo
[moo
❑ Yes
❑ Yes
❑.N1u1
❑ Yes
[D Ale----
❑ Yes
❑ lac
❑ Yes
[3-N-o
❑ Yes
[3-NT- —
❑ Yes Lf'no
❑ Yes No
❑ Yes Lj'N o
❑ Yes
Copy ❑ Final Notes
_
Date: 3
Continued

Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
❑ Yes
❑ Yes_
❑ Yes ❑ No
❑ Yes �No
❑ Yes
[-]Yes ❑No
❑ Yes U <lo
❑ Yes
❑ Yes rz�
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es ❑ No
31, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LWo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes eto
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes �O
34. Did the facility fail to calibrate waste application equipment? ❑ Yes uwo_
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes EJ N-o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention:
Facility No. ? ? Z 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:�
Mailing Address: ] U T
County:,T.►?�P'S�ar'�
DATE: 7 -- .1, t-" , 1995
Time: 1 Z.p 6 b,u
W5 itf`?,-
Ss.-1FZ
Integrator: i!�A q_ too 11 '5 Gy U d S - Phone: —
On Site Representative: QQ1V G,a.Gyc Phone:
Physical Address/Location: ,yot. h 9 M%k S Na R14 e= .nv '0qlvSi -`7S"2.-
Type of Operation: Swine L.-` Poultry Cattle
Design Capacity: Number of Animals on Site: 2 CX0
DEM Certification Number: ACE DEM Certification Number: CNEW
Latitude: Longitude: mil_ ;.
Circle Yes or No -
Does the Animal Waste Lagoon hav sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or4QWas any erosion observed? Yes o"No
Is adequate land available for spray? e o No Is the cover crop ad uate? �e or No
Crop(s) being utilized: CO hi-AA4av
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? &9or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Pro)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue fie: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or IC If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 0e or No
Additional Comments:
f r c.10N�5
Inspector Name ^
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

JUL 14 '95 11;46PM
FORTS CAROLnM DEPARTMENT OF MWIROMMM, HEALTH & NATIIRAL RESOURCES
DIVISION OF ZNVIRON)MC L KANAGM(ENT
Fayetteville Regional Office
Animal operation Compliance Inspection Porm
;* �gA1t3i'�1�Ji1�IF.R `
-�r�]SPEC�'ION:`DATS ��.. kx,.,.-gAFZK"Dim+ID�
zs
+Y+
v
5�-P0491AIM
3
All. questions answered negatively will be discussed in sufficient detail in
the Comments Section to enable the dewed Permittee to perform the appropriate
corrections:
SECTION I
Animal Operation Type:
Horses, cattle, sw poultry, or sheep
SECTION II
Y I N I COMMMCS
1. Does the number and type of animal meet or exceed
the (.0217) criteria? (Cattle (100 head),
horses (75), swine (250), sheep (1,000), and
poultry (30,000 birds with liquid Waste
systp-M)1
2. Does this facility meet criteria for
Animal operation REGI TRATI
3. Are animals confined fed or maintained
in this facility for a 12-month period?
4. Does this facility have a CERTIFIED ANTKAL
WMTF MANAGZMEBM PLAN?
5. Does this facility maintain waste management
records (volumes of manure, land applied,
spray irrigated on specific acreage With
specific rover crop)?
6. Does this facility meet the 5C5 minimum
setback criteria for neighboring houses,
wells, etc?
11

JUL 14 '95 11=46AIM-
SSG 01_g iI2
Field site xanacem t
Z.
Is animal waste stockpiled or lagoon
construction within 100 ft. Of a USGS
Map Blue Line Stream?
Z.
Is animal waste land applied or spay
irrigated within 25 ft. of a USCS Map
Blue Line Stream?
3.
Does this facility have adequate acreage
on which to apply the waste?
4.
Does the land application -site have a
cover crop in accordance with the
.T- IFIrATzoH LAN?
S.
Is a=imal waste discharged into waters of
the state by man-made ditch, flushing system,
or other similar man-made devices?
6.
Does the animal Waste management at this
fairs adhere to Best Management Practices
MM)
of the approved CmTm W
7.
Does animal waste lagoon have sufficient
freeboard? now much? (Approximately )
S.
Is the general condition of this CAFO facility,
including management
and operation,
satisfactory?
SECTION rV
Comments

i , 2_ rl7.s