820275_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

ITypc of Visit: B Com 'ance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — Arrival Time: �� Departure Time: County:
Farm Name: �eu l .� �� 1T131�/'ryt. Owner Email:
Owner Name: !!t'ar -e U Phone:
Mailing Address:
Physical Address:
Facility Contact: �t"?r/ /%rp�s Title:
Onsite Representative:
Certified Operator: C�jiS%n/ij-✓- /7Baj
Back-up Operator:
Location of Farm:
Latitude:
Region..,7/- �
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►arrant
Design
Current
Design Garrent
Swine Capacity Pop.
Wet Poultry
Capacity4b' Pop.
Cattle
@specify Pop.
Wean to Finish
i, La er
Dai Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish 3ZagDaia
Heifer
Farrow to Wean
©esigu
Ca Mot
Dry Cow
Farrow to Feeder
„'': D . P,©nl
Ca aCi
'Op.
Non-Dai
Beef Stocker
Farrow to Finish
Layers
Beef Feeder
Gilts Non -Layers
Boars
Pullets
113eef Brood Cow
Turke s.
Other a;
Other
Turkey Points
I 10ther
j
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)?
❑Yes Jt No ❑NA ❑NE
El Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J4 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes PLNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ /„
Observed Freeboard (in): 42-K—
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ill "'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 [r 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 environments threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes gfoNpo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [D 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 [21o ❑ NA
❑ NE
maintenance or improvement?
Waste_APRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes L "'o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. es ❑ 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 Hare Soil
ff-o-Qde of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
j
12. Crop TYpe(s)= �fl_ rA*1_ I _
13. Soil Type(s):}>7�3�
14. Do the receiving crops differ from those designated in the CAWMP?
es
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[?] No
❑ NA
❑ NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 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
/
[a'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stacking ❑ 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
Ejl o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�fo
[DNA
❑ NE
Page 2 of 3
21412015 Continued

lFacHity Number: - Date of Inspection: Q
�-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ffoNo
❑ 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
[ <o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[3" 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.
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes [�JNo ❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ffNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Q
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
R No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
DIN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
❑ NE
Comments {refer to question any! YF,S answers and/or any. additional recommendations or any,other coanments k6
Use drswmgs of facility to better explain sitnations;(nse addtmnal" paRes'as necessary)
;' �'�! u.l I,..
_ __.,..4,
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone:, 911V __ 5- 2 '.3` 0/,S/
Date: /p> _i l
-�r
214 2015
Page 3 of 3

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01Zontine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: r am-- Region: lc (Q
Farm Name: Owner Email:
Owner Name: r1_'1r are- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:Phone: /
Onsite Representative: Sir�c� Integrator:
Certified Operator: �'�j j Op/� ���b� Certification Number: ¢51
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design• _Current
Capacity ' Pop. Vet Poultry
La er
Non -La er
3
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
E]
DairyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
��DY :.P.,oult ,
Ga aci t,P,O
-Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No
❑ Yes M.No
❑ Yes JNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412015 Continued

• Facility Number: - az JDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fANo ❑ 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: CD ► f r� i
Spillway?:
Designed Freeboard (in): -
!
Observed Freeboard (in): I! C, �3y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes n 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 allo
❑ 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 Eg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E[No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ["No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
f
12. Crop Type(s): ar /yV'6'—_ 1'5374r� � ��flri�YGra�
13. Soil Type(s): KjV A-- -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [pq No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F;t No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ea No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[4 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
1 No
❑ NA
❑ NE
the appropriate box_
�
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes [P No
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ER No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: g2L - Date of Inspection: /d-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.No
r 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes RNo
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 Vallo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
D. I
61Z�'rP7_jA49_ "7- t7e'4)��
Reviewer/Inspector Name:
Reviewer/Inspector Sigmatur
Page 3 of 3
❑ Yes CK No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Z[No ❑ NA ❑ NE
[:]Yes &No ❑ NA ❑ NE
❑ Yes [a,,No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 3rdj--r/S /
Date:
21412015

ri
—_/l—/6 I�Q r
• t 'ion of Water Resources
Facility Nurnber ®- �Z, '� Division of Soil and Water Conservation
_ Q Other Agency
Type of Visit: ompli nee Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / 3 YI L Arrival Time: / : Departure Time: County: Region: 1
Farm Name: s f �� /jyti� Owner Email:
47
Owner Name: C� f �/ �.y Phone:
Mailing Address:
Physical Address:
Facility Contact: Per-,- Title: Phone:
Onsite Representative: �Q� ` Integrator:
Certified Operator: Certification Number: �q LI
Back-up Operator: Certification Number:
Location of harm:
Latitude:
,,
Longitude:
Design Current
Design
Current
Design Gnrrent
Swine
Capacity Pop.
WetlPonitry
Capacity
Pop-
Cattle
Capacity Pop.
Wean to Finish
I a er
Da' Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,oul . _
Ca aci
P.o
Non -Dairy
Farrow to Finish
Layers
I 113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other c k2'
Other
' Jlnia�x^F.r1Caa4�a�:.F i."""L.M1'1.L.1Aantl',ILE:9Ni3uNWu.,'.__-
�#� u-�
C. ""
Turkeys
Turkey Poults
10ther
�,^..:a:v.'.:itiwlS:�L6'il..'dF"JY.7tila
Discharges and Stream ImDacts
1. Is any discharge observed from any part of the operation?
[-]Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance ratan -made?
❑ Yes
[:]No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
FNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
,SLlo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®-No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
T-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
4 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
IS No
❑ NA
❑ NE
8. Do any of the structures 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
® 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
E�g-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN n 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): 42 (,Z4_-_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 1ANo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D4--No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
�.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
E3-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 O No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No
23- If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes R No
[] NA ❑ NE
[] Weather Code
❑ Sludge Survey
[DNA ONE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

` Facility Number: - Date of Inspection:
(p _
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
CE�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
E!�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 f .No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
[:]Yes ®..No ❑ NA ❑ NE
❑ Yes f &No ❑ NA ❑ NE
❑ Yes UNo
❑ Yes 52LNo
❑ Yes 54-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer- to question .# Explain any YES answers and/or any additional recommendations,or nny'other commeiiEts:
Use drawings of.facility to betterexplain situations (use additional pages as necessary): • _
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Paige 3 of 3
Phone: 'j D 3- 0 j
Date:
21412015

Fivision of Water Resources
Facility Numbe0 Division of Sot? and Water Conservation
Q Other Agency
Type of visit: ����ompliance Inspection Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: (a-Aoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: 1 43 : O D Departure Time: County: S' Region: > (7
Farm Name:FrOwner Email:
le
Owner Name: f j� a Phone:
Mailing Address:
Physical Address:
Facility Contact: �'��ri /�ipD/`� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Integrator: 6�__,.g
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
- Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design
Cattle Capacity
Current
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer L
Dairy Calf
Feeder to Finish
Farrow to Wean
7 DO
Design Current
D . l;oultr. Ca aci P,o P.
Dairy Heifer
Dry Cow
Farrow to Feeder
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
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)?
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2_ Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facility Number: - 7 Date of Inspection: ~! /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg 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): t j
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
RNo
❑ 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
U3_ 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
3 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
EINo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes fff 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): 15oeP7W r S
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® 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 C, No ❑ NA ❑ NE
[::]Yes [allo ❑ 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 [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 LS 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 rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 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 [A 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 Eg No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (, No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2 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
[3 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
allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
allo
❑ NA
❑ NE
Comments (refer to question #1)Explain any. -YES answers and/or any additional recommendations or.:anyYotheracomments_' � $
Use drawings offaeility to better explain sitt�abons (use additional Pages as necessary)':, mow, "�,y_;
Reviewer/Inspector Name: Phone: �-330D
oF
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

(Type of Visit: (7Co Hance Inspection O Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: �U}-I Arrival Timee: / =DD Departure Time: ; �a County: Region: -a
Farm Name: 4901tk r _ 1 !'DW Owner Email:
Jr
Owner Name: (rr / r�J {,{ f HA cv- % j Phone:
Mailing Address:
Physical Address:
Facility Contact: a-e-,'- Mn,,)1`'L Title:
Onsite Representative: Certified Operator: 14411
11
Phone:
Integrator: 1,f I/.,
'46
Certification Number: A
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
:Current
_;Design
Current
Design Current
a �ty
Swine CapMMU al
Pop.
Wet Poultry
Cap city
Pop.
Cattle Capacity Pap.
Wean to Finish
I 11-ayer
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
CuT_ent
D Cow
Farrow to Feeder
D . 1P,au1
Ca aci -
' Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other
Turke Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [a No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ Yes 0 No
❑ Yes El No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 21412011 Continued

Facili Number: -= Date of Inspection: /D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Structure 2 Structure 3 Structure 4 Structure 5
Lowry
Spillway?:
Designed Freeboard (in): P` A
Observed Freeboard (in): 30 3 E
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[B No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
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 Q 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 allo
❑ 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 0 Application Outside of Approved Area
12. Crop Type(s): 6,0 / i'l !N/7Y ��r t'�'71�a�-► S
13. Soil Type(s): D
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 M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EQ 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes to No. ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ W`UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 53..No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

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

Date of Visit: Arrival Time: Departure Time: ! Q County: a,___ Region: ` �d
Farm Name: �-t�l L y 77 HD* ��1'N Owner Email:
Owner Name: rJ t-t� �i(_3 H is %ne Phone:
Mailing Address:
Physical Address:
Facility Contact: 6y ?,,,-%pDr Title: L�­,-; 5an�, Phone:
Onsite Representative: ��.Integrator: f`-
Certified Operator:/%� / lJp� ��y f/> S Certification Number:y�-
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
F _
Swine ��pCa
P Design Current
act Pop.
�
ry�Currpent Design Cnrrent =` DP ga �tA
Wettl?oult Ca acePo Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Non -Layer Dairy Calf
= -" . Dairy Heifer
Desi Current D Cow
1) .P:iiult Ca acl -low Non -Dairy
Layers Beef Stocker
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Turkeys
Turke Puults
Other
Beef Feeder
Boars
Other, .`
Beef Brood Cow
Other f
Discharees and Stream Imoacts
1. Is any discharge observed from any part of the operation?
[:]Yes
;RLNo
❑ 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
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
�&No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
KNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: IDate of Inspection:
--/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
DqNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
K 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
gjNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
R No
El NA
❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E_No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Dg—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): ri'L f L��t S r��•• —�
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
Pcbj
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[A No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J4 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 jg No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gL No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
-f3
• 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IS 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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
®No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�K No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
g 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
D4 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
U4,No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
fZ No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3 No
❑ 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).
0" Gnu' w
Reviewer/]nspector Name: s/ ��/� �[�•y� Phone:
T
Reviewer/Inspector Signature:
Page 3 of 3
Date:` �d�3
21412011

C-03;29i
IType of visit: %v iiompnance inspection t1 Uperanon meview V Ntructure r.vaivanon u i ecnmcai Assistance
Reason for Visit: 0- outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: If �rrival Time: : 3 Departure Time: County: Region:
Farm Name: 122 u b L r-- c! }V p i- Owner Email:
Owner Name: �� y� y L4j. Ha _,-C= Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 07;�54=C , Phone:
Onsite Representative: �irr�c y
Certified Operator: ;
Integrator:
Certification Number: 2:2�z5�4_1,;;Z_
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desig�nCurrent'
Design
Cru tit
Design Current
Swine Capacity Pop
Wean to Finish
Wet Poultry
aer
Capacity
Pop
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
111on -La er
Dairy Calf
Feeder to Finish
""
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D . P,oult .
Dews g
Ca acI
Current
t Po .
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Dischar es 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 rVNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21417011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? []Yes 10INo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):`
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V1 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 [!I No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? f4 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 [DNA ❑ 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
C9�
12. Crop Type(s): �� /�c//1 r-� S S
,
13. Soil Type(s): L 0 A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement'? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Eq No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®No
❑ 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 Ej No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeili Number: -17 jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [A No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes LMANo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes I No ❑ NA [:].NE
❑ Yes No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes � No
[:]Yes RNo
[:]Yes ®-.No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or. any additional recommendations or any other comments: ` ` I'
Use'drawings of facility to better explain situations (use addrtionalipages as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:/p
Date:
21412011

(Type of Visit: Q'Comph cc Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint Q Fallow -up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: TO Departure Time: ; OU 1 CounYL59
Region:
Farm Name: %� �r f j p k Fd r rK_ Owner Email:
Owner Name: d a rre � Phone:
Mailing Address:
Physical Address:
Facility Contact: 19-e Y/— wopern, Title: Tlk jar Phone: /
Onsite Representative: 7-t _ Integrator: urd
le
Certified Operator:dr,r�`��,�� �� �� ��� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current;..
Design Current
Swine
Capactty P p
c7
WetPoultry
La er
Non -La er
Capacity
::,
Pop
Cattle Capacity P.
Ijahy Cow
Wean to Finish
Wean to Feeder
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
`"'
Design
Current
.
Dry Cow
Non -Dairy
Farrow to Feeder
La ers
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of 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 5INo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
[!�No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Faciiiiy Number: Date of Inspection: —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: fvr��l �..�
Spillway?:
Designed Freeboard (in): t' _ 1 y
Observed Freeboard (in): . 3 L ^ -3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Uj� 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? 0-Yes Oleo❑ 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?
t I _ Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Q 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): ,�C�rrt _65B 4u 'Afl /Gvfr
13. Soil Type(s): 'Xi0*_
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 [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ca No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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. [3 -Yes ❑ No
❑ Waste Application EgWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis tgNaste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LENo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

`. Faicilfty Number: -A74 jDate of Ins ectiion: — //
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 D NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Otber 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:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EgNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes UANo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? 5j Yes ❑ NA ❑ NE
Use drawin(§'of facili to'better explain situations use additional` a -es as necessa � or;,any otiier�conti�ents.
Comments refer to question Explain an YES answers and/or an additional recommendations"
g tY p ( A g )•
Vw R lu l f d l] �,p ; .-L (ov dalf r
v C cUfr Yo . Tr�� s rl`4'' L D w`� !`"°O
P
`74e-
TiAnyF-r'r
Reviewer/lnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L-!D
Date: L Q —�%
21412011

Type of Visit pMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (kl�outine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: % (Arrival Time: .3 0 Departure Time: I -7 . Va I County: �" Region:
Farm Name: Owner Email:
Owner Name �r Wa r� II , _ Phone:
Mailing Address:
Physical Address:
Facility Contactas � Title: Phone No:
Onsite Representative: /�!! r%ZDfls`'�— Integrator:
Certified Operator: i nr'��`3 Operator Certification Number:��
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = Longitude: 0 0 = 6 0 6f
Design
Current
Design
Current Design Current
Swine C►►opacity
Population Wet Poultry
Capacity
Population Cattle Capacity Population
Wean to Finish
Wean to Feeder
❑ Farrow to Feeder
❑
❑
El Farrow to Wean
El Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 09-No ❑ NA ❑ NE
❑ Yes
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 09-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[BNo
❑ NA
❑ NE
❑ Yes
V�Aio
❑ NA
❑ NE
Page 1 of 3 11/28/04 Continued

',
Facility Number:Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J9 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
J
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 15
Observed Freeboard (in): 429c3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JXNo ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
R!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?
JUYes
❑ No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
'&No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E• No [DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J,No ❑ NA
❑ NE
maintenance/improvement`?
i I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Farj�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window
❑/Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
IT 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 W No ❑ NA ❑ NE
- 3
Comments {refer to questton`#): Explain any YES answers and/or any recommendations or':any other comments .. .
€Use drawtngs`0 facility tolbetter_explain situattofls (use�addittonAl pages as necessary) . ,
06rk�Li f)
x� aaa.s ti>�ok�� �-- r �� f o
Reviewer/inspector Name fix. a
Phone:
Reviewer/Inspector Signature:
Date: p
Page 2 of 3 jr 12128104 Continued

Facility Number:— Date of Inspection O /�
• Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes S-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers DAnnual 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
S�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit?
❑ Yes
tRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26: Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
t@ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
V[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
WINo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J.No
❑ NA
❑ NE
Additional Comments and/or. Drawings: '� � � � � %«° ��•�
Page 3 of 3 12128104

I . .J
Type of Visit 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Qn �3 Arrival Time: Q<<3 AM Departure Time: j�� County: S SD'1 Region: �(L
Farm Name: `i �0,1% Le 4 t T-T IIM Owner Email:
Owner Name: L�LC_ Poore (T Phone:
Mailing Address: 1a�3 Gn1h14\ PCU F7AJ6-,
Physical Address:
Facility Contact: r_f �1�1L� I Rj�GrC�h�'n jj Title: LPtjPf P'f'fm ML%r Phone No:
Onsite Representative: Dfl✓fly) i7l) U�— _ _ Integrator: of hy-13(ow►'1
Certified Operator: l �j(� l�G f1 Operator Certification Number: �a C 3`3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = t = {i Longitude: El ° = ' = "
jffDesign Current.
Design Current
Design Current
Swine C►►opacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Da' Calf
Feeder to Finish R 33
❑ Da Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
Feeder
❑ Boars
❑❑Beef
Pullets
El Beef Brood Co
❑ Turkeys
Qther
❑ Other
❑ Turkey Points
ILI Other I
f Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
[]Yes
[]No
❑NA
❑NE
❑ Yes
❑ No
[]NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RNo ❑ NA ❑ NE
❑ Yes IR'No ❑ NA ❑ NE
12128104 Continued

Date of Inspection
Facility Number: —a
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
53No
❑ 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): Zq �{ -
Observed Freeboard (in): 3oA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I -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
�+lo
[:I 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?
JR Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R1 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
NtNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1547No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[--]Yes
1gNo
❑ 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. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tR-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J�[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
:Comments (refer to questi6n,4) .Explaia,any YESaanswe s and/or anyrre`commendaho`ns it other comments.
Use drawings of facility to better explain situations. (use,;addrtiooal pages {necessa5krnV
ReviewerlInspector Name Phone: ,� 3
Reviewer/Inspector Signature: Date:
V 12128104 Continued

Facility Number:$ -�k, t- Date of Inspection 110100
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JS 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 ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (RNo ❑ 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 Wo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [�[NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR-No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
UNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9No
❑ 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?
I/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J;�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
N-No
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Eallo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JRNO
❑ NA
❑ NE
A�diittonal�C mmeats and/or Drawl gs: � ��
-7, SO f l waJ h0vled t� ),eito eo can he,�, iv--? 16on aid f�a 1Veed �
S Ar s,p�, � rnvkA Ar I i �e cl Ane- ;� - ege °�
S 0� �
,5, Spi1 Sour 6 ��'? ��� Shores nflC'G� 'FtY � r/i1t? a'! S4�Q v�l� / ,DO/) O�
G Sae ro�4 h C1 ofi w -e&n OAP lw"t� yi, not jW-4 '5
w is was �r�i C �? 9 v 'J
�''n o r� -�'h -� J �a�l� �
Q. Niewfe,%01- nas P4} plrl'1�eG�
� _q t � -0" q_
12128✓04

Facility No. ga`ais Farm Name �p�b� [ Date t9�13�n I
Permit COC
Po . T e Des i n Current
OIC�
NPDES (Rainbreaker PLAT Annual Cert )
Design fr- - ... •
---_---
Observed freeboard (in)
y Date
Sludge Depth Lft)_ & 0/6
Liquid Trt. Zone (ft)
Mum, TIMI"In- M
Un—
Actua.!
Ali ��-------
lid
Soil Test Date _ W ttable Acres Weather Codes
pH Fields WUP Transfer Sheetsr.
Lime Needed - ma Y-9 Weekly Freeboard RAIN GAUGE
Lime Applied Rainfall >1" Dead box or incinerator
Cu ✓ Zn 1 in Inspections Mortality Records e�
Needs P 0409 120 min Inspections
Croo Yield
Waste Analysis Date
00O_�
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Ma
�vh kan13
C-
g s
. S
S
�
J �bs� ] • '
rJ� f
Verify PHONE NUMBER and affiliations
Date last WUP FRO qll S�ga R,9-- 3k10T Date last WUP at farm
FRO or Farm Records C`A - f1dPf0h191"j!
Lagoon #
Top Dike q�10
Stop Pump a3
Start Pump Qla=
Conversion- Cu-I 3000= 108 Iblac; Zn-1 3000= 213 Iblac
� C4
App. Hardware

a INS 7'vl fa iarOS
Type of Visit '8 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 19tRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1a. Arrival Time: �Jr IJ~' Departure Time: reaQ County: J LA
Region: O
Farm Name: Da-y-61 f V TiDg 1�h Owner Email:
Owner Name: W �Feff4 Sarre(( Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No: 38'L62T& l c 1
Onsite Representative: f Integrator: H-13
Certified Operator: " C MC Cpf �n Operator Certification Number: AWA 02 053
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ 4 ❑ u Longitude: ❑ ° = I = u
1,
�Dest n
C _ ...,
&urrenY �, Design Current Design
Current
gi
PERE::
Po ulation .a aci Po ei
, ,: ..._ P _.h,a Ph'to
ionPoury
Finish
❑Layer
❑ Dai Cow
to Feeder
❑Non -La er
❑ DairyCalf
o Finish
y l ;• ❑Dai Heifer
D Poult ❑ D Cow
o Wean
to Feeder
�" " Non airy
❑ La ers
❑ Beef Stocker
La ers
❑ Pullets❑ Beef Feeder
❑ Beef BroodCo❑ Turke s
to Finish
rFF
❑ Turke Poults
❑Other Number of Structures:
._. _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1 Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page 1 of 3
[]Yes fRNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
*�E] No
❑ NA
❑ NE
[--]Yes
�R_No
❑ NA
❑ NE
12128104 Continued

Facility Number: $a, — D-15
Date of Inspection $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ Old
Spillway?:
Designed Freeboard (in): q pay
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
WNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 'JR Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes
JRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
IS No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) COM'r Wh6li,SMV dednS
13. Soil e s
type(s) NoA' 1S I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D?No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5?No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[UNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ NA
❑ NE
Comments (reter.to gaestton'#�"Egplain any, ICES answers and r annintnendations or an other comments.
Ala y ,F4% � y
Use drawmgs.ofiffiCk!jty to better egplaid situafeons {use addittonal,pagesfas necessary):
Reviewer/Inspector Name F El ek Phone: Gil 0- 3- /
ReviewertInspector Signature: Date: Z)
17/7R/AQ Cnntinupd
- -I-- I

Facility Number: a- — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JRNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[:]No
[RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ELNo
❑ 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
JR No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ERNo
❑ NA
❑ NE
�. ►4 rev bo-e_ ,T f&j an OAId,;� ia�o, wa I S
19,Sor beonu rrc�-PtL I o f we-ek ,
rT, E*Ryi- ')00
Page 3 of 3 12128104

Facility No. $a—a�jS Farm Name .D ovhi!P 3N pa�$) Date
1A 16)8
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft& %
Liquid Trt. Zone ft
q
-b6
R- 11 •FFA�-
-�
Actual Width---Fir-
Soil Test Date 1 in Inspections
pH Fields Crop Yield 120 min Inspections
Lime Needed }� 0 -/f� D `�T/,4� Wettable Acres Weather Codes
Lime Applied WUP~ Transfer Sheets
Cu ✓ Zn Weekly Freeboard / RAIN GAUGE
Needs P jv-o-- Rainfall >1"
.6 ..
R
..VA
0
r �
C/
/
.ems, �;/
1
i ►
arm
Verify PHONE NUMBERS and affiliations �Unlc 1, i� — 0� Q1q; 11-7
Date last WUP FRO Jaj0&? Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike 99,0
Stop Pump Q,.(,,-'S3
Start Pump 4W3

C c�cd �"S Ia-s-o-?
-45
ONDivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit R Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �' a ,D1eparturee Time: � ; -t] County: Region: A
b( NLL
Farm Name: DOVOa �1'l ���CN�/�&I's r!/1 P410 �P� Owner Email:
Owner Name r 1-k e-e_- Phone:
Mailing Address: 6& `—hwCf1 PAL
Physical Address: L54h NC aT34 1
Facility Contact: M I C j_ HeC ItenTitle: 1e-uee /QLL Phone No: Q/33T— 03(0 C
OnsiteRepresentative: Mrk-e Hc-Civilfn Integrator: 4em I'v,,N
Certified Operator: h ida l He C 141en Operator Certification Number: X 5'3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 O = = Longitude: 0 ° = I = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�_� ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes ONo ❑ NA ❑ NE
12128104 Continued

' Facility Number: 00 7:�,— aZ-L'5­ Date of Inspection '-3J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E'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): ���� ;,8,4 uyS
Observed Freeboard (in): 3 S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes WNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ZNo
❑ 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 treat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
C'Yes WNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes C4No
❑ 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 WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 19 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R1 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)-
13. Soil type(s) �JiA,_-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes El No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes Ej No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes IffNo ❑ 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):
Reviewerlinspector Name 3 Phone: i 4 a Wi
Reviewer/Inspector Signature: Date: IQ -1s_ 0-7
12128104 Continued

Facility Number: 4g Z — a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes Wo ❑ NA ❑ NE
El Yes E9No ❑NA El NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CRNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
❑ No
CR NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
].�R No
❑ NA
❑ NE
❑ Yes
LgNo
❑ NA
❑ NE
❑ Yes ❑ No CR NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes rR No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
CRNo
❑ NA
❑ NE
❑ Yes
XrNo
❑ NA
❑ NE
Uec&ip fo* Croe -No sod eals h rvej4ed),
-rp'MsluT' _ 5"v ey IA a0�-j� "�} was dege anywa (not�farkd),
I-yoon i 1eeds,3nass sea or seQP aidmalcA�y an are 00b'k4 w411,
sago& s mo—yveH m owed, aJ, rn ast, hoof-jood cower,
12128104

a
Di=D!
ision of Water Quality
===XqUfiumber 8z, �7.J Oision of Soil and Water Conservation
1-RIM(TinewAgenc y
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint Q Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: -07-0(o Arrival Time: 9; /O Departure Time: I 1t9, 0 County: Region:
Farm Name: Dloub% T_ 4rkl, . _ [,r/Y� Iry /D6 AM/06r 1 Owner Email:
Owner Name: 1'VaLPhone:
Mailing Address:
Physical Address: l078�
dike,
�� ���j 0 9/O.3ffS,
Facility Contact: f ike AfC Culle-i Title: L/ ��Phd a 9/O. S9f . 0352—
Onsite Representative: N;c�,/✓ Integrator: P rCAV4v
.vdavri rrv�re 5
Certified Operator: 61-IffI • Ar, e Operator Certification Number: !JA ZZOS-3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ n ❑' = Longitude: = ° ❑ t = "
Design Current
Capacity Population
Design Current
Wet Poultry C►apacity Population
urrent
Cattle PCpulation
MINOR—
inish
7F�dner
❑ La er
El Dairy Cow
eeder
❑Non -La er
❑ DairyCalf
Finish 7Z0 g3�
-, ' `.;�: a a_
El Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑Turke Points
❑ Qther
Number of Structures:
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
P 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
PNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
WNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
59 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[51 No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ! 9
Af
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[A No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[A No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[WNo
❑ 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
5 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:1 Yes
V] No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
D9 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% 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) 6 7ea
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V1 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
0 No ❑ NA ❑ NE
10 No ❑ NA ❑ NE
D4No ❑ NA ❑ NE
IQ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers�andlor any recommendations or any other comments. z
Use drawings of facility to better explain situations..(use,additionaI pages as necessary):dR
�� / . 5�3 •33a�
•
_ _
Reviewer/Inspector Name - �$
Phone: 9 O 3 -,3
Reviewerllnspector Signature:
Date: 0 -Z Z
Page 2 of 3 - 12128104 Continued

Facility Number: $Z —Z7 Date of Inspection D-p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
❑ Yes
Up No
❑ NA
❑ NE
ElYes
[rd
p No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E$ No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes 7 No ❑ NA [INE
ElYes P No ❑ NA ❑ NE
❑ Yes [7'No El NA El NE
❑ Yes
7No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit (Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Qjibutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date or visit: 3 O 4 'Tune: Lli
Q Not Operational Q Below Threshold
[y�rmitted er&'�'hied © Coudlitionally Certified [3 Registered Date Last Operated or Above Threshold: _
Farm Name: ... a —or_ 7 .�°'� - FiU,!h ...W-----__ ._� ...... County:
Owner Name: . _u _.�.1�1� 1[ _. _ _. �.. Phone No:
N- twhn Address:
Facility Contact: r!�````}}}}- [►:r _.... , Title: Phone No:
Onsite Representative: _6ero Ann T Integrator: +!�O K'
Certified Operator:._... �!��(! �� _-- Operator Certification Number:.•._.. —..-
Location of Farm: �.........�_�..�.................._............---
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• r_�` �"
R -
�DesigAr Crt
DeSrgn Current x u Design ren Current
Si z ary _
Y
SwineniatzOn Popltryti ` _�F:, '-Po alation. Cable a Po nla�on
r
_
❑ Dairy
:'
❑Non-Dair}'
El
El
El
ca �a
El
u ?
otai SSLW ;s
Number of Lagoons
Wean to Feeder
'=
Layer
eedex to Finish
?
�p
Non -Layer
Farrow to Wean
-
Farrow to Feeder
��
Farrow to Finish
�. �..� Total Design
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑�
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes eloo
Waste Collection & Treatment ���
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M-N-0
Structure I Str�)ture 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: _.. _ -- - .� .. __ .. _..._.. _. .....- - -- - .......�.
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection a /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes Q'NO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes [a-3Qo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Bw
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes amo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes MNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,Q,fif�o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Iwo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type N 0- `t �+
13. Do the receiving crops differ with thos designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20, At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
L'T<o
❑ Yes
EWo-
❑ Yes
Ma Co
❑ Yes
Who
❑ Yes
❑ Yes
EPo
❑ Yes ❑.]?'
❑ Yes [}No
❑ Yes Leo
❑ Yes No

Facifity Number: Date of Inspection O
Reouired 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?
(iel 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
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32 Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes
❑ Yes
❑ Yes Owo
❑ Yes MIZ
❑ Yes B<O
❑ Yes U3,Ko
❑ Yes (�o
❑ Yes ❑ No
❑ Yes 9'No
B'�es
❑ No
❑ Yes
t90
❑ Yes
❑Yes
44N
i;��O_
❑ Yes
Qd►K----
❑ Yes
12112103

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVMONrNIEN]'AL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. 1 , 1995
Time.
11
Farm Name/Owner: P ,r Y % VA ay r e
Mailing Address: RouVe.. 1 , (3ox 9313 r-(iksorn, rC a8341
County: _ _ sGm �n
• T'
Integrator. '1Q M ��...,,. _ Phone:
On Site Representative: T)O%JC% Phone:JLO-Si'1-9219
Physical AddresslL.ocation: -- _ _-�h_ `/ Of C2;--Qfjen s v i 1(t - -- o k- .S F, #1W j
Type of Operation: Swine F!+n Poultry battle
Design Capacity: 8"0 &- i Number of Animals on Site:
DEEM Certification Number: ACE DEM Cwtification Numbcr. ACNEW
Latitude: N 3S* ' _$,' -,ja" Longitude: W19_' Jq ' 27,J
Circle Yes or No
Does the Animal Waste Lagoon have fFicient freeboard of ]Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes No Actual Freeboard: Wit. Inches
Was any seepage observed from the l oon{s)? Yes o as any erosion observed? Yes or�
Is adequate land available for spray . Ye or No No Is the cover crop adequate Yes r No
Crop(s) being utilized: cJCt�r-+
Does the facility mcei $CS in;nin?um setback criteria? 200 Feet from Dwellin s Yes r No
1.00 Feet from Wells . Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes rDNo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes CNo 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)? Yes or No
Additional Comments: L1 r rN S _
Inspector Name
Signamm
cc: Facility Assessment Unit Use Attachments if Needed.

`z REGISTRATION FORM FOR ANIMAL FEEDLOT OPE?,.ATIONS
Department of Environment, Health and Natural Resources
Division of Environmental Management -
Water Quality Section
If the animal waste management system
for vct:_ feed;ct ope=aticn
is
designed to serve more than or
equal to 100 head
of cattle,
75
horses, 250 swine, 1, 000 sheeo, o, 30, 000 birds that
are served
by
a liquid waste system, then this
form must be filled
out and mailed
by December 31, 1993 pursuant to
15A NCAC 2H.0217 (c)
in order to
be
deemed permitted by OEM. Please
print clearly.
Farm Name: --
Mailing Address: h'C'Je- Y
i
County:
Phone No
Owner (s) Name:
Manager (s) Name
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
milepost, etc.) n„L 0� _G;c ,S'z:.s;�,E[t_ 0,' Si; # 173E
Latitude/Longitude if known: �•<
Design capacity of animal waste management system (Number and type
of conwined anima; (s)) ayS'c;Fer�L'e.r-
Average animal Population on the farm (Number and .type of animal (s)
raised) f 41S'C he,-,L Fcilr A-0
Year Production Began:!ASCS TractNo.:
Type of Waste Management System used: Lc. oo-Trriw cA oyN
Acres Available for Land Application of Waste:
Owners) Signatures)
v
DATE:
`_ • - . - - - _ - ..- _ ^ r. i,.3:-.Lat.�s. fir. r++ •.5tu" ..� -