820293_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental Qual
II

yam --mid! -,-;, 0.j g r - - /.
Type of Visit: UCompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0-1 utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: %/,f- Departure Time: County::� �rrF,_,,Region:
Farm Name: r1 ��iJ !-� �cary.•U Owner Email:
Owner Name: �,.�Qcr.� "h�1�/ Phone:
4
Mailing Address:
Physical Address:
Facility Contact: IV,/ Title: DAjq Phone: Onsite Representative: Integrator: Ji , li�r �,/
Certified Operator:yr,.� Certification Number: 22i�,`lv/-,-, _
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
IN
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
3 ;L570
I
INon-Layer
I
Dairy Calf
IbZ Feeder to Finish
3&
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,ovltr
Ca aci
P,a
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
- -
- Turkeys
1 e. -
ITurkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ZNo [:]NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes �o
[:]Yes 21-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ETNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a l�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3No
❑ 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 j 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 Ef 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): n./rt
13. Soil Type(s):
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
ICJ N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U 'Yo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
j NNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
,--�
EK0
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Rio
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ff No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Qlo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ETNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - g3 1 Date of inspection: Jy :� Ist-
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0<0 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Fa 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 ffNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E N ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [1] No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes E o ❑ NA ❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
[]`No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question o 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). / `
M",
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
lj cr ✓7 \-� s Q / x-0--sr
Phone:
Date:
21412015

�a
.j
- ' vision of Water ources
Facility Number ®, O Division of 5oiil aW nd ateron Cservation
- -- � Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: I�utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —7 j Arrival Time: Departure Time: y County:
Farm Name: ��� f� cP-- �A� _ Owner Email:
Owner Name: _ d410�cz.w t ^ 3u/ Phone:
Mailing Address:
Physical Address:
Facility Contact:/O�t d. v� tLJ I �� Title:
Onsite Representative: Ste_
Certified Operator: 5-1
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:
Certification Number:
[—]No
Certification Number:
Longitude:
_
' .
`� �� Y� ent Design Current
EDesign Current
Swine Capacity Pop. VI'et Poultry Capacity P,op.
Cattle Capacity Pop.
T;
Wean to Finish
and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure El Application Field ❑Other:
a. Was the conveyance man-made?
[]Yes
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?
[8(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 .2/4/2015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fa No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L&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
�g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): / !., y,liC�✓�
//
13. Soil Type(s): G / A&r%r / U ,- -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�4 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
� 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
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
5�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 E!� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [0-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F'acili Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z�gNo ❑ NA ❑ NE
i
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 JK No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 54No ❑ 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 JK 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 q No [DNA ❑ 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
Ej 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
g] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: ��%ry�� �—d� Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

D -/6
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Type of Visit: OrlCompliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: & outme O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time:
, C� Departure Time: 'j
County: ��^� Region:
Farm Name: ���
��r mod-
rOt rv%'— Owner Email:
Owner Name:
�jL an —7—
Phone:
Mailing Address:
Physical Address:
Facility Contact: _� njrl gj� j2 .._ l�/ Title: Phone:
Integrator:
a
Certification Number:
Latitude:
Certification Number:
Longitude:
I)estgo .Current
Design
Current
Design Current
Swore' r_
C»p cetyFP3op. .
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
) lv {
T'"=
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P,oul
Ca act
P,a
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.. --
Turke s
Other
en '
TurkeyPuults
Other
.• .�:�..rt w�.. _..-- .;.:.., ... �-__-:...— _�._,. ,... .....- .::.. �
lother
::-lJ'- ' :, .�=.: ,.�..ew�_.�-_:.tefeae. -Fr_:A F ...
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3- Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes allo ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
[:]Yes
C&No
❑ NA
❑ NE
Page I of 3 21412015 Continued

- Facility Number: - jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ELNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes jallo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 5q 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
12. Crop Type(s):
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
LC* 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
2,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
J.No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D_No
❑ NA
ONE
Page 2 of 3
21412015 Continued

Facility Number: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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
P—No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
fA No
❑ NA
❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes E[No ❑ NA ❑ NE
❑ Yes [,No ❑ NA ❑ NE
❑ Yes q No
❑ Yes [K No
❑ Yes Jallo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question fit 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).
rr" vvr-
7D 01 Q
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone:p�3
Date:
21412015
Page 3 of 3

i
Type of Visit: Compliance Inspection V Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: (nrloutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival )Time: ; pQ Departure Time: : O a County: Region: FA L
Farm Name: J3u1l r,-- Owner Email:
�-- �j
Owner Name: �o h a74x# �- _d l l d-m 1 1r r� ��
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ,¢(,t1/7r-r Phone:
Onsite Representative: S`,� _ Integrator: /yI t3
Certified Operator: Certification Number: 4l� 6 et L
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
IIIl Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Cattle
Design Current
C�a-- Pop.
Pacitvm
Wean to Finish
I
JI-ayer
Dairy Cow
Wean to Feeder
I
INon-Lyer
Dairy Calf
Feeder to Finish
`7
�'
�
D . P,oul
�
Design
Ca aci
Current
$o ,
Dairy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[:]Yes ®,No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Ej�j No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ES -No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21417014 Continued

Facili Number: jDate of Ins ection: O-- /
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®.No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 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 allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [Z No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�j No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[S No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Lallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E&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): L'peyt �!V/fy��SBzr�r�s�. r ! 6i%
— —•
-
13. Soil Type(s): CO urll�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Pq No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JZ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 53,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 I�INo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes E4-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection: i7 r/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JE No 0 NA 0 NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes E[ No 0 NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Fj 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 Ca No ❑ NA NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes P�j No 0 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 file 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 Yes Ea No NA NE
Yes No [] NA [] NE
Yes � No ❑ NA ❑ NE
Yes
V�"i No
NA
0 NE
Yes
® No
NA
[] NE
Yes
® No
0 NA
❑ NE
❑ Yes
5g No
❑ NA
0 NE
Comments (refer to question I): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: sry_ cl� ��— ••� _ Phone: &L�_T jo-p
Reviewer/Inspector Signature: Date: 6— o /
Page 3 of 3 21412011

- i"vis'ion of Water Quality
Facility Number 1 O Division of Soil and Water Conservation
on Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: G— 1%rrival Time: f7D Departure Time: ; Q CountyRegion: or-7�
Farm Name_ C� fyyr ��ad Owner Email:
Owner Name: �l�7►7a+1 a�r�r:�- �W ��t' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: _ S'Gc.f,
Certified Operator: _ , fA�.
Back-up Operator:
Location of Farm:
t. -- Title: P,!;r
Integrator:
Certification Number: 4g wet (o
Latitude:
Phone:
Certification Number:
Longitude:
_ y Desi n C-orient Des' n Current Design Current g ig
Swine Capacity PopWet Poultry Capacity -Pop. C•atile Capacity P.
Wean to Finish Layer Dai Cow
Wean to Feeder Non -La er Da' Calf
Feeder to Finish Da Heifer
,4¢. ,...
Farrow to Wean ©estgn Current Dry Cow
Farrow to Feeder DPoulf Ca "actPo Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Beef Feeder
Boars Beef Brood Cow
Turkeys
Other
Other
Non -La ers
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)?
5J-No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E, No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes MNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 2/4/20II Continued

Facili Number: - I Date of Inspection: 7
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
n No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): 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
[gNo
❑ 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
g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[-]Yes
C,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 Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
PS No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[Z 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): A - � 5�9��✓ +-S • � G�J1�
- —
13. Soil Type(s): PnKJS UT u w.
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
FALNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[g No
❑ NA
❑ NE
Re4uired Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2.-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? I f yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Eyo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CNVo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

' Facility Number: 37 jDate of Inspection:
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if ycs, check
[:]Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
N No
DNA
❑ 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
[A 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
Pg 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
W No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z_No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

bins -ow 104013
illivision of Water Q�y ;y
Facility Number ga - ® O Division of Soil and Water Conservation
Other Agency
Fype of Visit: -0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: I$) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' 4 Departure Time: County: ,S61,1J5aj
v
Farm Name: Chd . kfgLf, GYn1 Owner Email:
Owner Name: U! Phone:
Mailing Address:
Physical Address:
Region: R2(;
Facility Contact: `f Title: Q}�}�j Phone:
Onsite Representative: 03 l�E1 Integrator: 114b
Certified Operator: 2 /)1bC4 DJAJ-af (rntQn MS Certification Number: Ow)
Back-up Operator: Certification Number: CROW
Location of Farm:
Latitude:
Longitude:
tGilts
.r -} estgnCurrent�h `Design@urrent�Design Current
a+ �* Capactty P,op. �Wet Popery Capacity . Pap _ Cattle Capaciy Pop.
a' Finish La er Dai Cow
Feeder Non -La er Dai Calf
to Finish "j �1.< Dai Heifer
to Wean _ # Design CurrentD Cow
to FeederD " PPoul a aei 10: Non-Dairyto Finish La ers Beef Stocker
Non -La ers Beef Feeder
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)?
❑ Yes Er No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
E] Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes CR No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes F�t No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [:]NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �—
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes � No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes N 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 P No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
-any
10. Are there required buffers, setbacks, or compliance alternatives that need
[:]Yes Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [R 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
❑ Evidence of Wind Drift ❑ Application
❑ Outside of Acceptable ro Wtyheall
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): N
W. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ 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 N 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
F�X[ 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. [53 Yes ❑ No ❑ NA ❑ NE
WWaste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No g] NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: in
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[,R No
❑ NA
❑ NE
❑ Yes
❑ No
N NA
❑ NE
❑ Yes
RA No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes to No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question 9): 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):
1, R dew ryfh4e- s�ra/ iev*ds w?e Icy
�!e CrYrt 01,
inter & 0 days I A4 tir w$e- nof- Vied L)r;(W s°?' av t R�t®f
COod W(k C1 eWj j /r'brush, itpp1) okebPrfi ej 157 �a nkr 1
0)s, SIudye 1tvelScre at OrY( Ofd iL-01 nfed ekan&,1 In C- - (�W -eaj, ,
F�Tm jmftm,P,AAOfe fD'fi�v -new � 6Dcd �'� r
O�C-�bimt lvar sv,-} 1a7�yecr b,f ho`� r�cu999 i�, �s, C%e o� 41G �c��ye �� m e-
ill 1fJdIlls �LM I� ���l�Ir� �IJ / 4Jfr� U ff0i, JdA3)f3
/�`�IL/`I.I {l', /� ]
Cc *cn,aj ,n& obove, lo��rd cofyJ.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
Phone: 910-i .6��
}
Date: �"�'013
21412011

Facility No: Farm Name
Permit ✓COC
Choi fTMC—It Date
OIC� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspill a
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Slud a Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
t
Date out of com Fiance/ POA?
Calibration Date
Design • .. i
Actual Flo...
----�-
-►�---�MM
Soil Test Date
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP �4
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu-I Zn-I
1 in Inspections ✓
Check Lists
Needs 5 (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
Waste D.aie--
s
..
..
MM
Verify PHONE NUMBERS and affiliations
Date last WUP FRO j 0104 9 FRO or Farm Records 1�o+f�,,�_ FpO
!1 f
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
1-0
Yv met � �
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

-b la I --I ]da-I c J-
--�i<'i` -.. - " ivi"sign of Water Quality
Facility NumbeDivision of Soil and Water Conservation
• � Other A en g �y
Type of Visit: 19Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Teason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time: Departure Time: County: .!�OpJpi
Farm Name: tf Folmf Owner Email:
Owner Name: �Cb�hal �, 6,*I`tr Phone:
Mailing Address:
Physical Address:
Region: FIRM
Facility Contact: M21flne,r%j✓'��j Title: Oj, for _ Phone:
Onsite Representative: Dj-�tl� Integrator: H-13
Certified Operator: al b $iCertification Number: Q!R69 2
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desig Current F , N Des�gti, Current 4 Design Gnrrent
Swine rCapacity Pop. Wet Poultry. Capac�tj POD. Cattle Capacity Pop.
Wean
to Finish
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 CR No ❑ NA ❑ NE
[:]Yes
[-]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
Page 1 of 3 2/4/1011 Continued

'I Facility Number: q -. jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R1 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): �19
Observed Freeboard (in): 35-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IS] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
h_ Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
n No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit'?
❑ Yes
CR 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
[3 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ l-leavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[d No
Lj NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
N No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CKNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
U No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
CaNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5j No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑C.hecklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. 'Yes ❑ No
Waste Application ❑ Weekly Freeboard Eg 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 ❑ No
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑NA ❑NE
N7NA ❑ NE
Page 2 of 3 21412011 Continued

• Facili Number: Date of ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [:]No NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes rg No ❑ NA ❑ NE
❑ Yes E�rNo ❑ NA ❑ NE
[:]Yes ['No
❑ Yes 2TNo
❑ Yes PS No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any. YES answers and/or any additional recommendations or.. any othiccomnients.
_ 1
Use drawings of facility to 6, ter i xplain sits itions'(use additional pages as necessary). 'y
�lye� mow p-d ta fo;.r a►rebtgr ad f��nel as )"5`,i��e j4s These W��
fie <� w$e cl�Pd co ca% of 0,�4 7� A � ��e n�-W
04,f . sae
7V
dDkn o�r a'1n�X l Tt1,1 nay G�A� 1a�� �� �r� �f,9
�- c o 0 afda
aq� - (odays, A dew qua evmfi rtee
Yv � Pa�d�s �r i Pad v� +he 0, alolw, P.4M rvfe'4
no
�p RR I has r vnrrf'0- rycao Ca?k � a hr InS 0 •
ilea __ 4e ccLn b & I w+� CDj
. TDxtb'I psed{ 01C idt In Hav� , Fo`m OIC -fhn rvaf 1r7 i"E'(
I rn�rpt�rr►r�'� �d'�rh 1 cracks f4al Oeftl l h'iyi t r s y - 07. Cx ► 'fir
,9 %
i `ar�f rc�2 a kxx;P
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q( 433 -
Date: tw at, a o 1a,
21417011

Facility No%D—Xq3 Farm Name a Date I d )I /A _
Permit _� COC ✓ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
FB Drops
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Slud a Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of com liancel POA?
Actual Di-
l�r1'------�
Soil Test Date 1Yl
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres ✓
RAIN GAUGE
Lime Needed .3 -
WUP -J
Dead box or incinerator
Lime Applied
Weekly Freeboard
06 h
Mortality Records
Cu-1 -" Zn-I
1 in Inspections
"J
Check Lists
Needs S (S-1<25) li�t�
3 �(� 120 min Insp.
ap j1 Alf
Storm Water
Needs P
Weather Codes . 1
�f?--
Waste Date
- 60 Day
+ 60 Day
N (lb/1000 G
5
..
..
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac

/Idof�
- '� aDivision of Water Quality
Facility Number ®- ® Division of Soil and Water Conservation
®Other Age,�cy
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: {Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 17 [A I Arrival Time: 0 Departure Time: County:_ Region:
Farm Name: 1� /c 4 F0/41 Owner Email:
Owner Name: -U-61 j24 T, 6L/fI-#- Phone:
Mailing Address: Its v M1,11 ,Sa6y b q@9-
Physical Adcdress: t{r/>j j
Facility Contact: r3zj Title: C vyn "
Onsite Representative: (S(6))4Q t? f / _ Integrator: —
Certified Operator:' Certification Number: T 3 7
Back-up Operator:
Location of Farm:
Latitude:
Phone: 33_-l03 /
Certification Number:
Longitude:
....
Gur nt
= �D sgnty
Cur nt
Design Current
Swine �,
Ca aci P,o
p
R'et Point Q. Capacl
po P
C stile Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
(p
= "".
:*
Dairy Heifer
Farrow to Wean
Design
...Current
D Cow
Farrow to Feeder
DPouit �...' =C.a aci
P,o -
Non -Dairy
Farrow to Finish
La ers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
OtherIMI
10ther
=.1r�-tee=w.
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes allo [] NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �;j No
❑ Yes 15kNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

@ 3 Facili Number: a. - UIr jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes nNo ❑ 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 �g No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
13-yes ❑ No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E5�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 Ca No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [5;a7No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes SaNo ❑ 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
LL ,^❑
12. Crop Type(s): rr� lJ�� h I ! JT11 r
13. Soil Type(s): l�VCLL�( ,JNo ,J rr B((//P1
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 RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes IR No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
DRrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records Documents
_&
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
rR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[SkNo
❑ 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 D 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 ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
N"N A ❑ NE
Page 2 of 3 21412011 Continued

F
[Facility Number: 53, - a23 1Date of Inspection: --)1aj1.1j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �RNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other lssues
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
CE�NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes tallo [] NA ❑ NE
❑ Yes Eff No ❑ NA ❑ NE
❑ Yes �-No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Fkf No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes V'No
34. Does the facility require a follow-up visit by the same agency?
[::]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.
Use drawinns of facility to better explain situations fuse additional Daees as necessarv).
�, NO e- rnow i'.sf ale- )aF,00q bm 0 OA clt� 04a f�'-rna-e_ *fMr a., MV a-M%/E
Cptn-, A15,o mow d a yde_ b94, whrc� rodbrush worCCec,,uv&9aT, (roaxik
id
arch C lacki 4n �} 4 o� ej' �'�`
�fm rrd#- on �a� ty6v k'
l r I �� sl �� �s vped ivo k elay rs =N ocr�Q�.so�
�o coilr ; y� �� 9 y k oU��
�/h r p w� � S r� D� s f
��1lmB-Q�n,y �0� O[ S'lc�C ,Sct'VP�!rr W1D sC
t-�AL Ht'e`
er r i ad-d "J Lek , (gaad iv& crn
1
at-a-F W& k hus bar, d � - i 01,e r -&'/, -1
�
i�il nil nod not al &L-t& Cal° r` Sys ;��e_s`' o&c i�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:'—�
Date:
42o�
OII

314
chA
6
*-
Facility No. S�-a`t3 Farm Name Date -21all Q
Permit -,/^ COC -,� OIC� NPDES (Rainbreaker PLAT Annual Cert)
FB
Drops
Lagoon
1
2
3
4
5
6
7
S illwa
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
,
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Design Flow
Actual
.]�'�-------
Design
i�l�----�--
Soil Test Date J
Wettable Acres RAIN GAUGE
pH Fields c/
WUP Dead box or incinerator
Lime Needed 0
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections
Cu-1 L - -'Z-n-4
120 min Insp.
Needs P PO R
Croo Yield �X Ir) - °
Weather Codes
Transfer Sheets
.,
..
FAX I MIN
E IT
a�
Ji
�
1
Verify PHONE NUMBS S and affiliations
Date last WUP FRO ?3G Date last WUP at farm
FRO or Farm Records f
Lagoon #
Top Dike
Stop Pump
Start Pump i
Conversion- Cu-1 3000= 108 lblac; Zn-I 3000= 213 Iblac
App. Hardware
oec� w k cvf+�J 6,+
yv* 1

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F .0201
Facility/Farm Name:y 3 & 77-eg
Permit #: /6 W 6- f 00600 Facility ID#: �C2 - 0�J County:-5A''',�'B
wSlae
Operator In Charge (OIC)
Name:
First v Middle
Jr, Sr, etc.
Cert Type / Number: Cz I/ 3 / Work Phone: (49 3
Signature: Date:
"I certify that I agree to my designation as the Operator in Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
Back-up Operator In Charge (Back-up OIC) (Optional)
First Middle Last Jr, Sr, etc.
Cert Type 1 Number:
Signature:
Work Phone:
Date:
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission.-
Owner/Permittee Name:
Phone #: w �5_6 Fax#:
Signature: Date:
( ner or,authorized agent)
Mail or fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
(Retain a copy of this form for your records)
Reviscd 8/2DO7

D IK,J c-vs 11110h
� . r-�-tIK
Type of Visit tWCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'Jj� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ff� Departure Time: S ' r County: Region: FRO
Farm Name: 44twet e ilEatmi Owner Email:
Owner Name: _6'emo- ti Phone:
Mailing Address:
Physical Address:
Facility Contact: Oak i"tQ'hQ�S'�tvt f �-f� � Title:.��aN� Phone No:
Onsite Representative: ALL Itat 4"l Integrator: H-8
Certified Operator: C—Inyio-1 Chad Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 1 ET Longitude: = ° = I ED 11
-- _- - Design CurrINK I ent Design Current
'Swine = C•apacity Population Wet Poultry Capacity Population Cattle
Design
Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
N Feeder to Finish
560 kbO
Dry Poultry
Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
i -., _ - ❑ Turkeys
Wil
❑ Turkey Poults
❑ Other ❑ Other
H,
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
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ej�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
B No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

acility Number Date of Inspection �D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): oZ
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
19 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
G�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? 15Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
t&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 Cl Yes
E•No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Wo
❑ NA ❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes
❑ No
❑ NA RNE
❑ 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
ERNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
MNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
§jTNo
❑ 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):
Nt� oayn.�
Reviewer/Inspector Name Phone: 33- �33 3
� }
Reviewer/Inspector Signature: Date: tv
Page 2 of 3 72128104 Continued

JL
Facility Number: $a —0jq3Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? `'Yes IENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA $2 NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �kNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
N NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
�? No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
KIIVA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
/"Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
b4No
❑ 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
I'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
Comments and/or Drawings:
by.JhA_vp, bodulde, of-110a7
V�f�
safe `0" r Sort �ta�rJ
I v nah ~a pisL� as lip -id
. p 'mit YYOr ndf' noiewed I, aooq_Sefieo^
shv
fs1i}l
&row►- eqe� S Jo self
PPas, �m o! ol�n I �� o �vr� r c 0aef d i'ree a? fgr 4-
L S emoF(lfr- te On 11�rn A1� t ID>wh
fob J �C WT
Page 3 of 3 A I -11Z61v4

CJlac�
Facility No.f)a-aa3Farm Name 6-,0C4F— Date III q1(0
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert )
M.1
MW
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
' R R -Design
��------_
Width
w � � aop
Soil Test Date
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
Weekly Freeboard Mortality Records
Lime Applied
1 in Inspections
Cu-I Zn-1
120 min Insp.
Needs P
Weather Codes
Crop Yield
t�v`� Transfer Sheets
Waste Analysis Date
- 60 Da
+ 60 Da
N Amt Ib11000 Gal
PH
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
*h
7qwp- Aj
03
20 5D
v v
Q,5_
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 31ab(py Date last WUP iat farm
FRO or Farm Records &vrW ke)� c� l 0
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac
_1L! I? YZ-f
App. Hardware

N
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 9"Fechnical Assistance
Reason for Visit 0 Routine 0 Complaint 1; Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: ; ' County: Sa -( Region: Fk
Farm Name: 1.0. 1 1 f F0(411 Owner Email:
Owner Name: (96? e f+oyft Y cu*- Phone:
Mailing Address:
Physical Address:
Facilitv Contact: C .h /l & -eyr Vf Title: _ /Y) a Phone No:
OnsiteRepresentative: Integrator: ffulehl4/0w
Certified Operator: Clcty�cy, C — Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = 5 = Longitude: E-1 ° ❑ d = «
Design Current `
Design Current
Design Curren
Capacity
Population
Wet Poultry
Capacity Population
Cattle Capacity Population
n to Finish
❑ Layer
❑Dai Cow
n to Feeder
❑Non -Layer
❑Dai Calf
er to Finish
r[O]Gilts
,3
❑Dai Heifer
ow to Wean
Dry Poultry
❑ D Cow
ow to Feeder
❑ Non-Dairyow
La ers
to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Beef Feeder
Boars
❑ Pullets
❑ Beef Brood CoYA
❑ Turkeys
Other
❑ Turkev Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Eyes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
SNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

1Facility Number. a — a
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J>_j No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a0 b mA'1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Si 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
2No ❑ 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?
5iryes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[2 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
ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�Vo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
E,;kNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
ER NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ffNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NNE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (vise additional pages as necessary):
33) a aM regveri�lj d0c vM' �01
mf � d I rti �-, df-hle d ea, o* a�ld- Crack -G'X e t
by mo f 1.
330D
(SPrkhhoJ_cvo- 33-
w
Reviewer/inspector Name '107ntm S h'M-6
— �- ^ ~1 Phone: C9+ 0 433-3 V
&
Reviewer/]nspector Signature:
_-
Date: a O
Page 2 of 3 V 12128104 Continued

314
Facility Number: <&a- —A3 Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA I�JNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ❑ No ❑ NA CRNE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA LNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No ❑ NA
5NNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No CSNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
NNE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No ❑ NA
ERNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes C3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
®NVA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JR No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
RNo
❑ 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
UNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
UNo
❑ NA
❑ NE
-(h is Was ct_ --%llowvp `I o c heck th ih-e new la al Mork�j f /Ifto114 b ['fv#� - 7 `
-J}m 6aber r h ` ' i�,1f.; `rth t� c U �h � roc( �a� SC4.-77rn smilers
3h� a�k�� wc+s lff
csjlr `N of*-v, cq1,, DlsuepanC � mar�� ''`1Q
Oda"` at Q 1 Qrroq `/ 0 aid Mlle h
be ���ye d�� c�F '�a-f- aPrme-6Lq �
U oo� ! f Year SfIPc—- �'PJ+�s Ivf 2 cxfi5►'�'1
by es mod- s ma d le n10.b rail i%+fD a d r1 ivh�chobab� O�i'a>r+(
A ll -- �
ha�y�wa��e r � ivl� asma�� hole t�l-Ne-4o hac�tl� �X ��h
S�fare wG � '� �' � � �I
H c said 104er-Ne& h�eiee_ had. 1� 04 he
d I��' ' h Dw � was�not ��� a
CU cI,eQ/10L.71 ,
� see WO-1jej i1aLle- I c e o�c[s'rnud � cmtles �n-f>le. sew
hichnP���
"RJfn1 1"a11d YVdrnO�`��d�'O�� YJ I�viS11 lmym(erig (e hoot 44pi / &I
} �1 Is V 011ce- ma r, : 4 rhV&C' plLs a ���!��, y,r� y I, ilg^ lei l I S P�✓e ar n ] c� . ( �� e a�
rvR- i WOTti ai AN& wed I'd nOt geed hirl chMe 4o chf:t-k fi-he 1!ja mcr k-et, 12128104

t
i�ac�ty�Naimbeir�
4
Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: `f rL% Departure Time: County: s Region:
Farm Name: 46fy CUf 7Pji/V Owner Email:
Owner Name: Phone:
Mailing Address: 332 eban
Physical Address:
Facility Contact: Cl- 17Ui Cf Title: FQIAI 4 /Illd�i _ Phone No:
Onsite Representative: Integrator: MT� 13loop
u �/
Certified Operator: C ff&* Operator Certification Number: 3
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ ❑ ' ❑ " Longitude- ❑ ° ❑ , ❑ "
r - r - ,� +-. } _ 1 _ '_ : • .,� aEF S ..
' Destgn Currentv. A , Design Current # y'Desgn C�urrent5
Swtne' ;Capacity. 1'operlatioti Wet Poultry ' ,Capacity �Populattoneh `CapacityPopIshon'
ate.._ , ..
x 9
❑ Wean to Finish ❑Laver ❑Dai Cow
❑ Wean to Feeder ❑ Non -Layer I ❑ Dairy Calf
Feeder to Finish 1��+ x ;t ❑ Dai Heifer
El Farrow to Wean El D Cow
-Pou�try Dry
�
❑ Farrow to Feeder Z . „�..� n :_ . �.
❑ harrow to Finish
❑ Gilts
❑ Boars
Other F
❑ Other
❑ Lavers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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)?
Beef Stocker
Beef Feeder
Beef Brood
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?
El Yes f�],-Nb ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
LINE
❑ Yes
❑ No
❑ Yes S�No
❑ Yes R'o
❑NA ONE
❑ NA ❑ NE
12128104 Continued

Facility Number: 4_3 hate of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
i�No
❑ NA ONE
a. Yves, is waste level into the structural freeboard?
❑ Yes
❑ No
D NA El NE
Structure 1 Structure 2 Structure 3 Structure •1
Structure
Sinicture 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
�R No
❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
r
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 EJ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
'QYes
❑ No
0 NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
JC Yes
t@ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V<No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
S?No
❑ NA El NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'�iNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
19'Yes
❑ No
❑ NA
D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes
V<No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
%No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�C' No
❑ NA
1:1 NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phon 133 3 J]C-�-1
Reviewer/Inspector Signature: A& Date:�l t f
rJ L11Z6/U4 c onunueu

Facility Number: 13A Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes E No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
'j�-No
❑ NA
❑ NE
the appropirate box.
❑ WUP ❑Checklists [I Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Siryes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 'Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ERNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
'Ryes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
TQ-NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes $�No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CR No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ 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
5JNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
7, P l ek) ,P— Cut Wds 4 sinajl i&to coer � Q�f f �i�l 6�Ik �',�or°�al s���s .
�St "r aG'o !S _ Aromrjt C-''/�� oe [ rU Che& � -i-eldr
pl a
� se coo -4sA ,
or W
�i od is leaik erl2►
� S
p Cr� p1 fQJn ! ry 4 Ord I Of el
✓/1/Cf�l iif
so beck ,SQanalfe frj s �°C{X�'�r s �t'� « �� �� Y rnCA
f-�i httf`e bDLtic�.l YYt �' a
eo
Page 3 of 3 = jj -, � �� Odd# ��- !1 M-Chj 12128104
Qi irSrs y v t 7 t�� �[CYt x� Purer CW, y

Fai;ility No. '3a oq3- Farm Name
Permit COC ,_
Pop.Type Design Current
Date fry
OIC NPDES {Rainbreaker PLAT Annual Cert }
FB Drops
Lagoon
1
2
3
4
5
_- -6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft & %
g.3
Liquid Trt. Zone ft
Calibration Date
1
2.
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu n ��
Needs P
Ff� 0-9-
Zn (40
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections
D. - f1�►11� i 7l' �'
•
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
•
•
••
••
F.
_ . ,
�.
•ice �
,
���
�i
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 3l� ate as Wt�t farm
iti����l�l�d� jo ro����^Ic`f
FRO or Farm Records rllm4a
Lagoon #
Tap Dike
Stop Pump Ck%lG ho
Start Pump
A p. Hardware
Zpi'O r 7-)I,0r--`
q a

��J jq b 9 (a(o9 -) -3,
Po>h�
- a3
Y— �f
-7) 4-�
7 1a3
b34
% )31,1,1
n '.1 vAl, weotlp( 9o�
AYchy� NG W�4
1009 - 5
J
Nc,ej jeJ-
id{ajo�

145 �3 laq
Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit OrCompliance 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
a
Date of Visit: Arrival Time: DepartureTime: . �'f$�K. County: Region:
Farm Name: _ H0Afy,CVff r--&Ms - Owner Email: F
OwnerName: G eA e_ / Gv* Phone:
Mailing Address: 333 N&I U Rilleb __ 01$3
Physical Address:
Facility Contact: C..h+ / [J11 Title:
Phone No:
Onsite Representative: Integrator:
1���
Certified Operator: \1 y ITD�f Operator Certification Number: A*A I 3g
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: Elo ❑ ` ="
Longitude: = o ❑ I = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
7
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
F==]
❑ Other
I
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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
w
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
ayes ❑ No ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
12128104 Continued

Facility Number:$,k —;LgV Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): Q Lf
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IR 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
ITlo
❑ 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?
C3 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C'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
El Yes
TgNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
�rNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of// Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Area
l� L ,❑
12. Crop type(s) �•[JhfbTAL�l �fT4 P� . SG 0+3 r 90,kop_I� `1Oa+
13. Soil type(s) AUCOfrk S 1 �X� s1 ; Nodal k U -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
RYes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
C'No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IR No
❑ NA ❑ NE
Comments {refer toFquestion #): Explain ,any YES answers and/or�any recommendations or any other commeats.
�1
Use drawings of facility to better eaplam sitaatzons(asete�ditional page§4as necessary):
p ,_
Reviewer/Ins ector Name ��.
g
�� �_
11 >o i1;: 5 ���L � �' � Phone: 3`.�
Reviewer/Inspector Signature:
Date:
Page 2 of 3 V 1Z/2Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D9 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 El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
C5No
❑ NA
❑ NE
❑ Yes
[:]No
®NA
❑ NE
❑ Yes
UNo
❑ NA
❑ NE
❑ Yes
12 No
❑ NA
❑ NE
❑ Yes DiNo ❑ NA ❑ NE
❑ Yes ❑ No ER NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes 79 No ❑ NA ❑ NE
❑ Yes f R No ❑ NA ❑ NE
[:]Yes
CKNo
❑ NA
❑ NE
❑ Yes
[,No
❑ NA
❑ NE
Additional Cotnroen:ts and/or Drawings ;y`
a. i�iQ 1 bl Of�f'Ivrh �l i�2. � �f-►�e�.� betel up a. sma ii ��., f (bd-s'ocll�
1earL blocks bef�e Catiffild-ip a- aw,�[ h� ha��� , .T oil►
`arm r �o SUa u rrhgfJ,T Jew jhd f yed ��- on S ef�( il'11 t' Uo
r,
4ri� rear - OA fan i fm� OICC 1' 1 9
-71 Heabe, CtItsrnqiI *106 4b-Ij PJ i jide
D#i bo.) OOAd-
hjAh hew'b b6r s off ©n la b�, ,1 �-0�l k i.siA
ark, �l e ^ � a �a� r �
i dr�eto d3 ry � A m dS
c� I, �� g er �ti°f C �0 p %e 5 , . e&r. let d wt ri r� �an� t n Whe�--i'+ irel U
Is' Soy earls � Q�, Joif Iy lwb',IdA 4 k Il , ebarn a_ e ,s
y ha , w 1 r�jc�d C „�s ,►�` b� oFa ki 1IedwPd Ptoru-6
v�y�o� S �P o � �? 9
cS VVP -6 " a00 S
, Famdo6 no+ v �
Page 3 of 3 12128104

. Facility Number: Date of luspectiowistanosr I�ev1�lD�rAddr#ro-, �7J �171 �1aQI�`
Additional Comments and/or Drawings:.:
Addr-inn 4o a: Sf jai- aW- aid 4id riot re�i d i� n-�-h attar
-gyps ,,-V,e Wa* , Ne4-Iy q[l q f- l f i.Jd- I n-G H*d b y -he- —6-e of
aJ kea- 4�e`(�im6� 'r� pwr +te rem off, i iq ad- back i OD The ,!�cq.5age-
- e d i(f urdewoaf� 0 ierWe i+ w W� C etn -0l1 d iH
Add 4ion+O 15,• PQ ��,� j( b2 0 � '�QP fi` �s �41(as Vs (. � r j/
hops s-evd-a ( load -(' eIds or) w h rch +o
s R ev trial . FO-ci I I fY i t YC)l f-oY, 'S'l4les"gyve Gaoxd � � PRO
Plea 04va I slid Si,-f a �f
��doa � �b e,di?F o
y
4130/J l

Facility No. aQ3 Farm Name
Permit COC OIC
Pop.Type Desi n Current
FB Drops
Date F,+,;% 1 it}�,
NPDES (Rainbreaker
PLAT Annual Cert )
Freeboard
1
2
3
4
5
6
7
Desi n
BIMS
Observed in
SI
d e Survey Date Perm Liquid (ft)ilr
Sludge Depth ft
5�
i.l
Calibration Date
1
2
3
4
5
6
7
8
Design Flow
Actual Flow
Spray Flow
Design Width
Actual Width
3
Soil Test Date cQ 1(11a
pH Fields
Lime Needed
Cu W1W Zn ✓
Needs P
Crop Yield 1 in Inspections
Wettable Acres 120 min Inspections
WUP Weather Codes
Rain Gauge Transfer Sheets
Weekly Freeboard V 3
Rainfall >1" ✓j-
FMA
• 1 I .
�L��
•.0 � 11�7�
a4 f n 1a6-�a la�io7
Pull/Field
Soil
Crop
Pan
Window
1
Siv U
13.13��rP
11►
i-
go
_sue
B+,"44
3
SP
S—
.-t-
r
0,35'Irdhe -Ij�3 70141
as 1^ /hr-P ,P1d ii
5-Av 11 b,-i/)r$. SG
�a F>ittdy
a �tS~- fii�e(J3
301E �`�y

` e Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 10 Arrival Time: -AQM Departure Time: �Q.` 0 County: _,.S'iFlrrY;Ofj
&eqcA
Farm Name: /+,, �f - M Owner Email:
Owner Name: �VLR-- rl00tw r-4 Phone:
Mailing Address:
Physical Address: _ J � T�1f
Facility Contact: Chad do _ Title:
Onsite Representative: {�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: = e
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ uTkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 KNo ❑ NA ❑ NE
❑Yes
El No
If",
❑NE
❑ Yes
❑ No
P NA
❑ NE
YNA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
)14 No
❑ NA
❑ NE
12128104 Continued

t
Facility Number:
Date of Inspection g
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No PP NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 [1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[jiNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
XW 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
�TNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
K No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PLNo ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydrauiic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) GMSQ
Gam► m5vm ( 1r1
r
13. Soil type(s) 4.4 1 FXA' kn*
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ID No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�Y No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: O 3
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection Malt 11
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C§No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Pq No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1'10�6DNo ❑ 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 F No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
03 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
RjNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5a No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
F1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
®No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
[j 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
Y1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

4
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �(i Arrival Time: 6. t7 Departure Time: �Q County': jSflir'riP50/1� Region:
Farm Name: �,'o,YLiL�'�IC1Uf Rwms Owner Email: r
Owner name: Ge* ec 140 nf±1 ewPhone: jd gbq ag3J
Mailing Address:
Physical Address:
C,
Facility Contact: _ 17 QrW-1,1 C L 'Title:
Onsite Representative: _(� tfOY1BI! Ct. _
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator: !' l i�lA' Q h y
Operator Certification [Number:
Back-up Certification Number:
Latitude: = o = I = 1
1 Longitude: ❑ n = 6 = 11
f _,]
Dairy Cow
❑
Dairy Calf
; r s : r.r
' ❑
Dairy Heifer
❑ L a ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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?
I__I ev*ii,-vai,
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 9 No ❑ NA ❑ NE
❑ Ycs
❑ No
XfNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
�a NA
❑ NE
❑ Yes
❑ No
[:3 Yes
�]No
❑NA
❑NE.
❑ Yes
[ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 Date of Inspection Ib
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
Km No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No XNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o I�
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[!�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9 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
0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®-No ❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
10 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) �T: l o I EX A
-_
LJ I-
�f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
D� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
51No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IN No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
.Use drawings of facility to better explain situations. (use additional pages as necessary):
1
T
Reviewer/Inspector Name Phone: %D'
Reviewer/Inspector Signature: Date: 6ri
Page 2 of 3 12128104 Continued

� 4
Facility Number: 2 Date of Inspection /0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes F1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D9 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ANo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[& No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CA No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [�No ❑ NA ❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9A No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
IN No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[S No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
59 No
❑ NA
❑ NE
Page 3 of 3 12128104

t -.
eQ H.Q q.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: O`y : OA Departure Time: .) County: ,
Farm Name: Ho k 4 n d u C{ Ea r k, 5 1 u e� _ Owner Email:
Owner Fame: ^ e j a 4 Phone:
Mailing Address:
Phvsical Address:
Facility Contact: (OL a el H 0" p t! e_ t, 4- Title:
Onsite Representative:
Certified Operator: do iL e A,1
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Region: JrAu
Operator Certification Number: -0 jWjj
Back-up Certification Number:
Latitude: ❑ o = , Longitude: ❑ o = ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La yet
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urk-ey Pouts
❑ Other
Discharces & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made"
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E]
b. Did the discharge reach waters ofthe State? (]fves. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system? (Ifyes, 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?
❑ Ycs EKNo ❑ NA ❑ N E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE t
❑ Yes
[3No
❑ NA
❑ NE
❑Yes U o ❑NA El NE
12128104 Continued

4 4
Facility Number: al —all Date of Inspection
%Vaste Collection & Treatment ��,,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L9No ❑ 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): j
Observed Freeboard (in): .P D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage.. etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2"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 D-f' jo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes G]�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q-'Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [i?No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Daft ElApplication Outside of Area
12. Croptype(s) _?>.w U-0140L /
gat 14�rc�-y � �C` �i i�-. ".,+
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ErNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;�Ko
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers'landlor any recommendations or any other comments.
Use drawings of facility to bettereaplain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone: Q/0 My _ 1sy/
Reviewer/inspector Signature: Date:
12128104 Continued

. ,
Facility Number: (�' a Date of Inspection
Required Records & Documents ,,��,//
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 0340 ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2/No ❑ NA ❑ NE
❑ U'T wdte44y+xc ud ❑ Vt:es�gsis ❑ psis ❑ W49Msfers 'on
❑ Rainfai ❑ Stm+ing ❑�7 ❑ 120 spechos ❑ M ions ❑ Wzath�
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Qhio
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E9"�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�To
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ENO
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[ E
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[-,,h�o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El2 Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
El Yes
,,��,,!!
[9/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
►'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ED. 44o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E 1No
❑ NA
❑ NE
Add itiy
A�n
ona! Comments and/or Drawings: p 1
44 C ror yeiW'ee�vt�J
12128104

�tiy,x ��, t �t� ��F'Ft (� D1VLS' UTt Of SOl� &O� WHtEi COOSCIYHtl00 r _ � �w--� r„ c F �
•..F' � � A 'Y`I� "s.^a W ..f Wrr J -' F - '.`.Y^. - '�'
Type of Visit e Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit ORoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility• -Number
3 Date of Visit: Time: = �
F57, -ot O perational 0 Below Threshold
IM Permitted ® Certified [] ConditionalIy Certified © Registered Date Last Operated or above Threshold:
Farm Name: 1-I or%r-.. e-.--+-A- Fa „ C_ - County: 50_V..#Maig 12t?
Owner -Name: ®GeP% r-` / N ti .. -�� _._._ Phone No:
/V
Mailing Address: 3 3 7 a I /a2 td. AgW4elaunix3M
Facilitt- Contact:
Title:
Phone 'so:
Onsite Representative: Integrator: ryh^� 12%%:{—
Certified Operator: C►, "k u she... e- -A-+ Operator Certification Number:
Location of Farm:
ly Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 0 � Longitude ' �• �-
Design Current
Design Current Design Current
Swine Ca acitri• Po ulation
Poultry
Ca acitv Population Cattle Ca acity Population
❑ %1,7ean to Feeder
❑ Laver
I
❑ Dairy
® Feeder to Finish
G 7
❑ Non -Laver
❑ Non -Dais:
❑ Farrow to «'ean
❑ Farrov.- to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
I
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Laeoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid waste Management System
Discharses & Stream impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Svrav Field ❑ Other
a. If discharge is observed, was the conveyance man-made.)
b, if discharge is observed, did it reach Rater of the State? (If yes. notif}, DWQ)
c. If discharge is observed. what is the estimated flow in galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
?. Is there evidence of past discharge from any part of the operation?
3. Were there an3, adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Svillway
Structure I Structure 2 Structure 3 Structure 4 Structure
Identifier:
Freeboard (inches): ai
05103101
El Yes CZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No [ it
❑ Yes ❑ No
❑ Yes ® No
❑ Yes j)� No
Structure 6
Continued

Facility Number: f,7 — j' Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes M No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ]] Yes ® No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ® Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/mprovement? ❑ Yes 09 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes IX No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. is there evidence of over application? If yes, check the appropriate box below. ® Yes ❑ No
❑ Excessive Ponding ® PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &-yr, , Aa H—w _ S*gLesna ui.c.��i 5••�•1l �rd•�..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes R] No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 4No
Air Quality representative immediately.
- -. --
Sc���a
ti : ••,•:� 1p � 3 fi o
VVGr app�,�dTiOU
"CeSSar_V)1 ® Field Copy ❑ Final Notes
or. -t-%..c 03 6u tr s<e Z tvbfa a.- t avnr -t1�� SdIL.
S (4o�s. G lgww.P 4M.dL } otacs
Qy� 11,�+aIA&J W h j
7- rn a w 1 rt n c. V. r� a N IL S 0.r. 1 a w e O ws c &) wC� d-4A% - r 5" c.N %t P C r • ,
CI s'_ o�. r►.ti� -i^ u r+-+ oo r Lj c� � � 1'Gt! S Gor.-pa'}��^� i o.,] '� ws 6,e+rr•%v.otc*_
i c.,\j S.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
.. r
is.... �. .,� Date: g /D 2 /ov
12112103 r/ Continued

Face[ity Number: & Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ® Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes [Z No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IN No
❑ 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? ❑ Yes Rollo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes W No
26. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) ❑ Yes PQ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ja No
28. Does facility require a follow-up visit by same agency? ❑ Yes ® No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes j No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) PO Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ® No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ® Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
Er120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: N o
Facility No. B z - 513
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 118 , 1995
Time: B:oD_ .
Farm Name/Owner: Harr
Mailing Address: 51(, Road Auh-23yi-fic- n! G 2 g 3 r 8
County:
Integrator: T, de. Phone:
On Site Representative: Phone: 56> - (QoY9
Physical AddresslLocation: prQ�-r ' to
Type of Operation: Swine Poultry Cattle
Design Capacity: _ N j Pr Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) -Yes-or-Nu tM A Actual Freeboard: t� _Ft. -NYL-Inches
Was any seepage observed from the lagoon(s)? Yes (Xvas any erosion observed? Yes�a•(,YPr
Is adequate land available for spray? Yes -erne Is the cover crop adequate? YcrvrNs ►iIf-
Crop(s) being utilized: M i Pr N LA-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Afes=-No NVpr
100 Feet from Wells? YesN Apr
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes-es-W N tA-
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Ye*er-No Nth
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yerm -No Wjp _ 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)? YesOr-No N (A
Additional Comments:_ ._moo, kr wi+L Mrs . t-p �„c j Y47 i 11 SI S7 - S tle-
Cd,�
Inspector Name
cc: Facility Assessment Unit
Signature
—'A c. Der c — [ OLA 40 D ^
Use Attachments if Needci.