820297_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
II

I ype of visit: 0 Compliance inspection V operation Review V Ntructure Evaluanon V l eclinical Assistance
Reason 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: ty: v qk County: (�anpsbn
Farm Name: _}2yT j AG�$OL^ Ito"rrtn Owner Email:
Owner Name: Z LV..l Phone:
Mailing Address:
Physical Address:
Facility Contact: & , LiG n Title: Phone:
Onsite Representative: 21%.� l ra.K w� ! �S Integrator: .Jrrlr���o,
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region: Fyz-7
Design Current Design Current
Capacity Pop. We# Poultry Capacity Pop.
SwineEE
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current
Dr. l;anl C_a aci P.o
Layers
Non -La ers
Cow
Non-Da'iry
Beef Stocker
Beef Feeder
NJ
I Boars
Pullets
Beef Brood Cow
Other
MF—Ft'her
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes �j No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
[:)No
[1p 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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

lFacility Number: jDate of Inspection:7/2-5/07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
)Q NA
❑ NE
Structure I— Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Jf
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
figNo
❑ 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 N3 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�PNo ❑ 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 EF�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [F=p No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window• J ❑ Evidence of Wind Drift ❑ Application Outside
_of_Approved Area
12. Crop Type(s): �Ql'tS-4I %�1�04R SS �f' )�� ,. [ -.. � 0��✓�"'�
13. Soil Type(s): NL01:2G i� Pie
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CIPNo ❑ 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 [4>No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [P:'No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box_
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
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?
❑ Yes [P No
❑ Yes $ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility•Number: Date of Ins ection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Qq)No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
CP 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
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
R No
❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[0 No
❑ NA
❑ NE
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[y] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[)3 No
❑ NA
❑ NE
Comments (refer to question f: Explain any YES answers and/or any addiitional recommendations or any other comments.
Use drawings of facilitvto better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: Q 1 b —l/ 3 -.3.3X
Date: lq
214,12011

i ype of visit: W Lompuance inspection v vperarion xeview V mrucrure r,vaivauon V i ecnnicai Assisrance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: — Departure Time: ILD7 County: Region:
Farm Name: ZZ Ja c*_SO0 `"M Owner Email:
Owner Name: `12o 64- ! 44On Phone:
Mailing Address:
Physical Address:
Facility Contact: �Q�
4'ckon Title: Phone:
Onsite Representative: `I Integrator:
Certified Operator: y Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-
Designs Current
Design
Current
- Design Current
Swine
Capacityi P�p:
Poultry
Cap�acty- Pop.
apci
Cattle Caty Pop.
Fet
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
-
-
DairyHeifer
Farrow to Wean
D Cow
Design Current
Farrow to Feeder
D . P,oul
Wa a i
P,o
Non -Dairy
Layers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turkeys
Other
*_ "'
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of 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 Pq No ❑ NA ❑ NE
[::]Yes
[::]No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
[-]Yes
[::]No
NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
tRNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

IFacility Nu ber: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes `❑� No NA ❑ NE
Structure 1
Identifier: �!
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l�
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes (�No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
qTNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P 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
QJ)No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )�qNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Chop Window ❑ Evidence of Wind Dri4 ❑ Application Outside of Approved Area
12. Crop Type(s): �_XA�>t A;VA U
LA)L"t
13. Soil Type(s): Y=4 — NA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� [�No
77
❑ 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
[�g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 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 Qa)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 991No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
FDNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
jf?No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes r,,No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [:]Yes Po ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question#} Explain any YES°answers aadlor any addrhonitl recommendatianslor any outer comments.
Use dr'awtngsoftfacrittyto better.eaplatn,siivat,ons(use additional pages'as,necessary)
elo qJ0-62q_-f0y1
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature:Date: F�
Page 3 of 3 21412015

i ytac vi ♦ anaa.1WaJvw}/uwucc auoY«,uVu V —P.— vu V ­aua.auac ­auwaa V aca.uuacaa ---
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Si1'vv4f -50rJ Region: p
Farm Namez J7" : Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: Facility Contact: cj7aCkmTitle: Phone:
Onsite Representative: Integrator: �Gc.,p-riLFX✓�1
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Current
,. Pop. Wet Poultry
Design Current
Capacity Pop.'
Design Current
Cattle Capacity Pop.
Wean to Finish
I
ILayer
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Non -La er
D , P,oultr
I
Design Current
Ca acic Po
Dairy Calf
2
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
-
Other+. -
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 1 No ❑ NA ❑ NE
[:]Yes
[:]No
NA
❑ NE
[:]Yes
[—]No
NA
❑ NE
[—]Yes
[—]No
NA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3
21412014 Continued

IFaeility Number: 2q-7 J Date of Inspection: j jtW js
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
fNo ❑NA ❑NE
[-]No 1p NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
gt
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [!PNo ❑ 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 P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P 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 �O] 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 Kj 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 ❑�?Eviden f Wind rift ❑ Application Outside of Approved Area
12. Crop Type(s): �gct$4d ,9G CTle-S Sic ,• �--,
13. Soil Type(s): B"+r�f7D [ �___ I`p/4-
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes to No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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 Dq 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 [];No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes [�j No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes Mn 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. 1P
❑ 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 2No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
to No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
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
No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L O—y73- 53co
Date: Z /6-
21417014

Ii ype of v fsft: W I.ompuance inspecuon V vperanon Kevfew LJ structure Evatuauon V t ecunteat Asstsianee
Reason for Visit: 4D Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ 2Z- Arrival Time: , ;/ Q Departure Time: . t c2:9 County: 5Ar^es0^) Region: PRJO
Farm Name: �` V a.40t\ Fa.,-M Owner Email:
Owner Name: i� /V K��� Phone:
Mailing Address:
Physical Address:
Facility Contact: TO le' M" { Title:
44
Onsite Representative:
Certified Operator:
ll
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
/Aeve L
Phone:
0-2
Certification Number: ' / G/
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design. Current
Capacity .. Pop.
2 T
Wet Poultry
Layer
Non -La er
D . P,onitr
Layers
Design
@opacity
Design
Ca aci
Cnrrent
Pop.
Current
Po .
Design Current
Cottle Capacity Pop.
I Dairy Cow
D2jg Calf
Daig Heifer
Dry Cow
Nan -Da'
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
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 [Ig No ❑ NA ❑ NE
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
[�j NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[i] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

acili Number: 2 - 22 Date of Inspection: 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [D NA ❑ NE
Strucre 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
W No
D 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
0 No
D 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
rW No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[�PNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
[�PNo
❑ 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 A--rAAeay�
J❑ \❑
12. Crop Type(s): G454-1 "S $ �l'� � -0-, ©
N� �l e
�e1.1
13. Soil Type(s): 1+
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes W No ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No ❑ NA [] NE
[:]Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[SR No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[g 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
EgNo
[] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes © No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi dumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes]
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
[P No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[)I No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[)!�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes q No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes
[�a No
❑ NA
❑ NE
❑ Yes
(A No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
(2 No
❑ NA
❑ NE
Phone: fpflg�41
0
Date: D L(
21412011

Type of Visit: ! Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 10 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1. Arrival Time: Departure Time: {(; County: S�JJ Region:
Farm Name:t6+�
J �it_i���, y� yl/� Owner Email:
Owner Name: e tA.'V+ - r Phone:
Mailing Address:
Physical Address:
r _
Facility Contact:®(� _ Title: Phone:
Onsite Representative: l� Integrator: PU1
N
Certified Operator: Certification Number: 1 003
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design —Current `¢ `" Design Current
Design Current
Swine 'Capacity ::Pop Wet Poultry Capacity Pop.
=
Cattle ILapacity Pop.
Da Cow
Wean to Finish La er
Wean to Feeder
Non -La er
Da Calf
eder to Finish
r
Dr Heifer
Farrow to Wean
Design Current
D COW
Farrow to Feeder
y
ul h Ca _aci Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
m
Turkeys
Other
:�,,f_`m ;
Turkey Poults
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes M No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [:]No W NA ❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [j] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [3 NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes f5d No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 21412011 Continued

Facility Humber: - Date of Inspection: I Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZPNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ®NA ❑ NE
Structure t 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
?j 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
iU
[;a 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?
T
Application
_Waste
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``,,,, ❑ Evideence of Win Drift ❑ Appl/ic�attiion�Outside oofpApprroved Area
12_Crop Type(s) 1��_Y►-'�SSi �? . �iH�-�7► i "�'rr�7Cr�
13_ Soil Type(s): t j&,/-41 V--4s r
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes W 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? TT
17. Does the facility lack adequate acreage for land application'?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N 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
171 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below,
❑ Yes
P§ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

ffacirty Number: Date of Ins ection: j Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �g No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P 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 [Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [5& No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes P No [DNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
Co No
❑ NA
❑ NE
❑ Yes
V] No
T®
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers andlor any additional recommendations or any other comments. I
Use drawings of facility to better exalain situations (use additional pap -es as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 /0 `3 r33Up
Date: 7 I Z
21412011

Type of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: 40 Routine O Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: � Arrival Time: O l y� Departure Time: Waft— County: S� PSBN Region:
Farm Name: `1GTC �M f rh Owner Email:
Owner Name: R&Y- Uae�sblr, Phone:
Mailing Address:
Physical Address:
r
Facility Contact: Title: Phone:
Onsite Representative: N Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desve
Design Curren#
Design C•urreot
_ign�CHurrent
Swine Capacrty Pop „ _ IWet Poulfiy Capac�t` Pop.
{
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
canto Feeder
Non -La er
I
airy Calf
Feeder to Finish
Design,: Current
airy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
-
1) , P.oult Ca ci Pao
Non -Dairy
Layers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
tibuYY°�•'•`^.-•a•-:..:SeM-raTi.fNi':.L.oi_.s_n .: A-:::3.:y...,r'wwW1.
Other
w.Y.ad?iY.�..._uiEe-, i. . •— w:r r. 5-.�Li'..::. .: ii`_.,
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ®No ❑NA ❑NE
❑ Yes ❑ No QDNA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
[—]Yes ❑ No
[:]Yes ® No
❑ Yes No
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Flicili umber: - Date of inspection:
Waste Collection & Treatment 8
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [hNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [;a NA ❑ NE
Structure I
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[4 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 ERNo ❑ 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 ❑ Eviiddencel of Wind Drift ❑t Application Outside of Approved Area
12. Crop Type(s): L kxt314' �1 [4'r �� U [+`T"'u, r h DwrWil M. f 1'-�, ctyLtsl�a.�l.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [50 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [$a No ❑ NA ❑ NE
❑ Yes tQ 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 El Yes Tl 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 1� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes [�g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [4 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Iracility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? etl'611 t ❑ Yes CR 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?
God fd,-M.
61)tC( Ru" V� ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
[[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
D Yes E&No ❑ NA ❑ NE
❑ Yes [�] No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes
[� No
T
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ZNo
[DNA
❑ NE
Phone: 3-
NOV
Date: 71�11/
21412011

A
IType of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access jI
Date of Visit: fs Arrival Time: tffi Departure Time: County: �/ ^� Region: 0
Farm Name: J Cr61^ N" Owner Email:
Owner Name: r Phone:
Mailing Address:
Physical Address:
Facility Contact: lY'lm'�"' "as�"� Title:
u
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator
IF I
Operator Certification Number: Z90B3 _
Back-up Certification Number:
Location of Farm: Latitude: = o =' = if Longitude: [� 0 0 & ❑ `&
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle NowCapacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
Dairy Calf
Feeder to Finish 1 2400
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
[PNA
❑ NE
❑ Yes
❑ No
1P NA
❑ NE
71NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
P
❑ NA
❑ NE
❑ Yes
IV No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

"t.
1
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes [2§No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No FNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35`
5. 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 E�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ No [3NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) r
9. Does any part of the waste management system other than the waste structures require ❑ Yes y❑ No ❑ NA ❑ NE
maintenance or improvement? f
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance/improvement? t
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window idence of Wind Driftt El+Application Outside of Area
12.
Crop type(s) ^ i�7"n-t,� QIF�rwa
� f�
r
13,
Soil type(s) /V& 04`, A,& � � -a
-,
— —
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
0 No ❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
PNo ❑ 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
R No ❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
W No ❑ NA ❑ NE
Reviewer/Inspector Name
Reviewer/inspector Signature:
Phone: 7/0-
Date: 6 .
Page 2 of 3 [�ila'vq
,3�- 33w
Continued

w "
Facility Number: Date of inspection D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ej�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
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[gNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
QNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�hNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
99 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[PINo
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
I --]Yes
� No
ElNA
❑ 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
[ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Gomments�a�id/�o�Dr��wing` s�,� � � '' i :� ��
Page 3 of 3 12128104
Page 3 of 3 12128104

I
7'ype of visit: W compliance inspection U t)peranon KeView V atructure Evacuation u t ecanical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of visit: 9 Arrival Time: Departure Time: County:_5;47-i�-VSd,4.) Region: �-�
Farm Name: Des at Owner Email:
Owner Name: j�4k sa%Lor%- Phone:
Mailing Address:
Physical Address:
Facility Contact:
21ey c ack Title:
Onsite Representative: k
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
�
gn�11Current,
Design
Current
Design Current
W-Deti
Srvi neapacitywPop
:Wet,Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean
La er
Dai Cow
EtoFinish
Wean eeder
Non -La er
DairyCalf
Feeder to Finish
m
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D P.oul
Caa'ci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
Turkeys
Other''.
Turkey Poults
Other
Other
Discharges and Stream 11"Daets
1. Is any discharge observed from any part of the operation?
❑ Yes
P@ 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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
•V] NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: -- - 2-9 jDate of Inspection: .o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes G]a 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 [i] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
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
�No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Qj No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�5No ❑ 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 Y, 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 �D No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NP No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaMity Number: T2 - 9gi jDate of inspection- o
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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)
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 15� No ❑ NA ❑ NE
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. [:]Yes [�%No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes M No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [1) No
34. Does the facility require a follow-up visit by the same agency? [:]Yes [A No
omments (refer to question ft Explain any YES answers and/or any additional recommendations or any
se.drawinQs of facility to.better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
comments.
Phone: [phone]- _?a9
Date: 3
21412011

Division of Water Quality
====ce-fliumber—� w`� 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit 9 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IJ Arrival Time: r��Departure Time: Q�"i.,.. County: r� Region:
��Farm Name: _ "aC�� F2et _ m Owner Email:
Owner Name:_ 2D&f— VAckSoh Phone:
Mailing Address:
Physical Address:
Facility Contact: aasbo-Ln Title:
Onsite Representative: H
Certified Operator:
Back-up Operator:
No:
Integrator• k77� L-L
Operator Certification Number: / 90
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = & 0 N Longitude: = ° = 1 = u
Design
Swine Capacity
C►urren#
copulation Wet Poultry
Design
Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish �O 1
❑ Farrow to Wean Dry Poultry,
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
Gilts Non -La ers
Fc]Boars ❑ Pullets
❑ Turkeys
Other ❑ TurkeyPoults
❑ DairyHeifer
❑ Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Po
❑ NA
ElNE
Discharge originated at: [IStructure [IApplication Field ElOther
a. Was the conveyance man-made?
❑ Yes
❑ No
�+lA
(
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
[:1 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
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes "' No ElNA ❑ 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 tructure 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
(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? r1Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes
❑
No ❑ El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
? No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) Cws`!-d T)�[7
13. Soil type(s) IV&r-(v [k__—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
43No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Com` ments(refer to question #) Eiplaun an yYES ans,ivers and/or an recommendations or an other comments
Use draatngs o[facthty. to better explaYn situations (use additronal.pages as_necessar}} J'
LL) ®V�' are°, S lQ t-k
Reviewer/inspector Name * t r Phone:
Reviewer/inspector Signature _ Date: (e
12/2404 Continued

0
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ElNA ElNE
❑ 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 rainbreakcrs on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
INo
❑ NA
ElNE
ElYes
NA
El NE
❑ Yes
No
to
❑ NE
❑ Yes
9)No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
❑ No
DNA
❑ NE
❑ Yes
�To
❑ NA
❑ NE
❑ Yes
IRNo
❑ NA
❑ NE
❑ Yes
[To
❑ NA
❑ NE
❑ Yes
Y_No
❑ NA
❑ NE
❑ Yes
L f—
❑ NA
[INE
❑ Yes
f'No
❑ NA
❑ NE
12128/04

i
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: tw3Arrivall Time: Departure Time: County: �� Region:
Farm Name: 1�X �3a L�� Ric rn _ Owner Email:
Owner Name: ,RQ 6✓ = Ja-CESOh Phone:
Mailing Address:
Physical Address: yam, �
Facility Contact: ,P06. t `"`-ickokl Title: Phone No:
Onsite Representative: H Integrator: i..N12
Certified Operator: Operator Certification Number: %9Ing�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [::] c = ' = W Longitude: [=] o = ' 0
Design Current
Design Current
Design Enrrent
Swine
Capacity Population
Wet'P.outtry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da Cow
❑ ean to Feeder
❑ Non -La er
❑ Da' Calf
Weder to Finish
DairyHeifer
Farrow to Wean
D_ry Poultry
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
_.
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
dumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[,UNA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DI
❑ Yes
❑ No
RNA
❑ 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
NNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
"No
ILP
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IANo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
11128104
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes lP No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No RNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4VI
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes rNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes IFNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EpNo ❑ 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
1�No ❑ NA
ElNE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
P No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Area
iyL � `
�
12_
1❑
Crop type(s) ��t min sm. `h owsud
13.
Soil type(s) iq
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
qjNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
F�No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
1P No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
P No ❑ NA
❑ NE
- M . t*(le ((44 - t S,
Reviewer/Inspector Name '+�' i r — — Phone: 0
Reviewer/Inspector Signature: Date:
Page 2 of 5 I2/18/04 t,orarnnea

Facility Number: — Date of Inspection E_A=1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA El NE
the appropirate box. ❑ WUp ❑ Checklists El Design El Maps El Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 P No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
X) No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
{�] No
[INA
❑ NE
and report the mortality rates that were higher than normal?
f
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PNo
❑ 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
71 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
E
Page 3 of 3 12128104

S Division of Water Quality
Facility NumberEK�4
0 Division of Soil and Water Conservation
O'Other Agency
Type of Visit ® 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: r���QQpw Departure Time: j County: 5� Region:
Farm Name: _ac-smn�+-" "Owner Email:
Owner Name: L�D1'1 Phone: C110)
Mailing Address: � /rtlL% ►9i'1 A�2f ,Ajc A19300P,
Physical Address: l�
Facility Contact: Q
— f 'D'� Ia"✓i Title:
11
Onsite Representative:
d
Certified Operator:
Phone No:
�}A �f 1
Integrator: ! `'1 W �--�T�1�t U rt STA. I
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = =" Longitude: 0 ° = I = u
Design Current
Swine Capacity Population
�❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish rol
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design _Current
Wet Poultry Capacity Population
❑ Layer
❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Design
Cattle "«Capacity
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ 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?
I
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
E�qo
❑ NA
❑ NE
❑ Yes
EQ�No
❑ NA
❑ NE
11/18104 Continued

Facility Number: jbr4— �J_Date of Inspection / Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
El Yes *PNo ❑NA El NE
❑ Yes ❑ No B NA ❑ NE
Structure 5 Structure 6
5_ 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 allo
❑ 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 V No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,�p] No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ll
9_ Does any part of the waste management system other than the waste structures require ❑ Yes `B No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1�No
ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes V No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) b2ZW1Aja&rgs5 C&4 5m. Cry Oaysea, Fegc� (t654Lcg C&rK
13. Soil type(s)
E�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F No
❑ NA
❑ N
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detertnination?❑ Yes
09 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
FNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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):
fiu, . Weit �l't�rhTrry't r�cB�ixs.
Reviewer/Inspector Name Phone: 1f7 33�00
Reviewer/Inspector Signature: Date: / 0%
12128104 Continued

Facility Number: — Date of Inspection fi +� 7(Qr1J
Required Records & Documents 1�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [29 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes
MNo
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Cy No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JP No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El NA
El NE
If yes, contact a regional Air Quality representative immediately
rNo
1'
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
rNo
❑ NA
❑ NE
12128104

i
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit r Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0 r Departure Time: County: Oh Region:
Farm Name: I� G T Llct50�I, Owner Email:
Owner Name: !1 Phone: r�
Mailing Address: 1 �41 �-�� AGI f ` 1—E �_ Ar C 2 ��
Physical Address:
Facility Contact:
Onsite Representative: D
Certified Operator: Rah- 5acko✓l
Back-up Operator:
Title:
Phone No:.
Integrator: P—rflm +s l t''Yl 3i �1Y1� R
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 1 =Ag Longitude: [�] o = 1 = it
I I Figi Design Current
.�r
Destgti�Ciirrent
Design Current
Swine 2Capaty Population
Wet Poultry =Capactty�Population
Capacity Population
:Cattle
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
-Layer
❑ Dairy Calf
Feeder to Finish 8 ft
;.?:_
❑ Dai Heifer
❑ Farrow to Wean
= L
❑ D Cow
❑ Farrow to Feeder
Dry Poultry :
-
❑ Non -Dairy_
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
ers❑El
Beef Feeder
EBoars
Nets
Pullets
❑ Beef Brood Co
O1tF r
her
❑ Turkeys
❑ Turkey Poults
-a
i
❑ Other
❑ Other
r
Number•of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
1P 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
VaNA
❑ 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
/❑
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

"a
l
Facility Number:
Date of Inspection G�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
95No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
16 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
tr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
US 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
QjNo
❑ 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?
PYes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EP No
❑ NA
❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
X No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable iin,, dow ❑ Evidence of Wind DDr�ri'ft"w ❑ Application Outsideof Area
`Crop//��Window
,,
12. Crop type(s) l�P.�f mgcL I C7� �t'�2 Ste. � l CAn\0 l � 5gj t J�tr - I?-rn22
I su'OA
G'n4(Ai Gyr�
13. Soil a" I
IG
&Zx:n
type (s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
n No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
fS 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
W No
❑ NA
❑ NE
Comments:.(refer to queshaA ff)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): _3
Sam men C_ 50n Co Sty ?� - �raCess
1. Kip `0 V\- (�LStot-, Baxllk5l
Reviewer/Inspector Name � � � � Phone{�-33VO
Reviewer/Inspector Signature. Date: O-
rage 4 0/.3 r414oiv* Lonunueu

A
Facility Number: 0 1-0Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 93,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p El Other'
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[]Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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 ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IQ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
8 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E? No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/28/04

r
Ficth#y'-Number
02
j
7
® Division of Water Quality N
Q Division of Soil and Water Conservation
0 Other Agency. _f
Type of Visit ® 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: ,3 J a %Z'S Arrival Time: Departure Time: County: r__�12.s Region: P Q0
Farm ?Name: �o_�• �'���r� �o-r w� Owner Email:
Owner Name: Phone:
Mailing Address: i y ri �l F—C cd2 yY. N, I1 rz.Q-
Physical Address:
Facility Contact:
Title:
Onsite Representative: W9 �_G_FS_t3 r%
Certified Operator: _1R,,be+r -,I--
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: — — � � �+�A{•�
Operator Certification Number: 1 9 d 83
Back-up Certification Number:
Latitude: = Q = , Longitude: ❑ 0 0 , ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
❑X Feeder to Finish
di s. &
1 00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke y Poults
❑ Other
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy I-leifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: F
b. Did the diseharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does d:schar(Ye 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 dischar-e?
❑ Yes R No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[[ No
❑ NA
❑ NE
❑ Yes
[)[ No
❑ NA
❑ NE
72128104 Continued

r
`Faciliiy'Number: Cd� — "2-7 ] Date of Inspection a d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[4 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): ct '1
1r
Observed Freeboard (in): 307
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 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
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
50 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O 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) ♦ram .� r G: c r t c A
13. Soil type(s) lam,Alogg
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination` ❑ Yes
[;9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
© No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers. and/or any, recommendations or auy other coinmeots.
Use drawings of facility to'better explain situations. (use additional pages as necessary):
f'
✓� Q7, i � ►C7 !' I .ti4 .� � n � W �� t � O r. I a �t C t� A} ran : � � Pa - f- �
Reviewer/Inspector Name �— n .-, � ��• .n Phone: o yyL -- 15'V
Reviewer/Inspector Signature: Date: -3 % a / 0 4—
1 12/28/04 Continued

'Facil y'Number: ?.1- —.2?7 pate of Inspection .? v
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes © No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ® Yes ® No ❑ NA ❑ NE
the appropiiate 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 I" Rain inspections [V Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ No
50 NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
Fi] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LA No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
© No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[YI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
M 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
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
F(] No
❑ NA
❑ NE
Additional Comments: and/or Drawings:..
12128104

Type of Visit &Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit _o ine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 19 1 Time: DD
Facility Number 4 7
O Not Operational Q Below Threshold
0 Permitted 0 Certified © Conditiionaliy Certified [3 Registered Date Last Operated or Above Threshold: ...... .—__ ..... -
FarmName: —~cJCs°r'--...........__� .............•-••---• — County:
Owner Name: :. Phone No: �?
�- ;49'4A
_ ._..................................._............._�.._......---......_............ _._... _Sb......._...�6 _......_.
Mading Address: ` _lLt ._.... d.. 1 . Ave L'o 'q
Facility Contact: Title: Phone No:
R0 ke`l _.__.n....-=.:Onsite Representative ........................ ......................................... Integrator: ...
..........— ........ .. ,�� �..
Certified Operator: !.`� 7"`X sO &` Operator Certification Number:
Location of Farm:
R rswine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' 44 Longitude • ' 69
Disebarses & Stream l_mpacts
1. Is any discharge observed from any part of the operation? ❑ Yes [T10
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ff<0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ["NNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZrNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ ......................._.................----................----................
Freeboard (inches):
12112103 Continued

Facility Number: I? Date of Inspection Lla o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E?90
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes Q�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 maintenance/improvement? ❑ Yes [v"No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes 03No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes QNo
elevation markings?
Waste application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 2<0
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [1g'fqo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop ripe &.rlon A , rrs,� . ia!',n Mc . SW41 ^rti ►,
13. Do the receiving crops differ with those designated in the &rdfied Animal Waste Management Plan (CAWMP)? ❑ Yes Q�lo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ago
b) Does the facility need a wettable acre determination?
❑ Yes
UKO
c) This facility is pended for a wettable acre determination?
❑ Yes
[210
15. Does the receiving crop need improvement?
❑ Yes
2<o
16. Is there a lack of adequate waste application equipment?
❑ Yes
2<0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ff 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 Ef No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes eNo
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 MINo
Air Quality representative immediately.
Comments (refer Lt► gtieshon #} Explara any YF.S artswaadloF a r�econneAdatsoiis ory othrr comments.
Usc drawings of fsty to better eacplam sttuaboas. {ase adt<onal pages as aecrssary) Field Copy ❑ Final Notes �`
.- ...L`.. ...:....r ' ,...,._.s___„.sL.._. "r#?... "' - �a e'Y'�-,,,..-,..��:5"�.u��'n,., ,�.._�,_.-. ..,. :r,.., �-�__,..- �._�... W.,__sa... ,. ..�uu,�?�_.' ..w:.. .:�.zb
erar s loolf d 1
r �
let
rr
Y
Reviewer/Inspector Name 'q
Reviewer/Inspector Signature: - Date: It,2 04
77n7ml fl—i —1-11

Facility Number: 17- —31 Date of inspection 9 v
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
QKNo
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
[vrNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
fffo
❑ 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
[(No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
C3 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
[2140
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
GR"No
28. Does facility require a follow-up visit by same agency?
❑ Yes
[3 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[-To
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35) [:]Yes To
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 l" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

if
State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Govemor
Jonathan B. Howes, Secretary
Mr. Robert F. Jackson
1494 Feed Mill Road
Roseboro, NC 28382
Dear Mr. Jackson:
,I", a
1DEHNR
DIVISION OF WATER QUALITY
April 18, 1997
SUBJECT: Annual Compliance Inspection
Jackson Swine Farms
Registration No. 82-297, 82-115
Sampson County
On April 16, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facilities. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facilities were in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facilities.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 486-
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Wilson Spencer - Sampson Co. NRCS
Wachovia Building, 5ulte 714, FayettevUle N%q � FAX 910,486-0707
North Carolina 28301-5043 C An Equal Opportunity Af mx dive Action Employer
Voice 910-48&1541 50% recycled/10% post -consumer paper

Roritine O Complaint O FoRow-u of DW ection O Follow-ua ofDSWC review O Other
Date of ingm tloa
F. Facility Number Z.
Time of Inspec ion a; use 24 hr. dme
Firm Status: e � Tots! Time (in boors) Spent onRevlew
or Empecdon (indodes tmvd and processing)
Comar
Owns Name:. Phone No: (910) Srf`— ?V/Z
Mailing Addr�st: iy5� ��EO�i%7%/,c�cfls,��d.�v � nlc � �,.3 �.2
OMM Representative: 4� - S�• so c� �`,co.� `.a.�-/ r
Operator Cerdiiendoa Number:
Location of Farm:
Latitude Longitude �• �' �''
0 Not Operational Date Last Operated;
Type of Operation mod Design Capacity
ia�.Y% '1.�„3K "41Y�. Y s..,,.Xnyla. S� r'.'}•6y 'T�^7'tA. i'Rs`. !aRw �l ., AM
+�Mhri3Y"f
Swine' � NamberpQYs�'
R . -_
. .�
Feeder to Finish
Namber of L�grwns 1 So�dimg Ponds -�� ; Subsurface Drains Present a
Spray Field Area -
I.
Are there any buffers that need tnaintenance!uonPrvvc=nr?
2 Is any discharge observed from any part of the opal?
a. If discharge is observed, was the conveyance mao-made?
b. If discharge is observed, did it reach Surface Water'! (If yzs, notify DwQ)
G If discharge is observ4 what is the estimated Dow in gaVmm?
d Does discharge bypass a lagoon system? (!Eyes, notify DWty
3. Is there evidence of past discharge From any part oEthe opetstiaa?
4. was !here any adverse impacts to the waters of the state other than from a discharge?
S. Does any part of the waste management symm (other than LgooaAoldiag Ponds) require
mainttnaa�mt?
Q Yea g{No
Q Yes 19No
Q Yes ®No
Q Yes M No
QYta
IMNo
❑ Yes
IS No
Q Yes
®No
❑ Yes
[] No

6. 1s fidIft not in Gomplisace wifi may WUcalde sefiark pia? -
7. Did the bdi tq fiil to bave a cerOod opunw in nqa=bh thine Cdi apecaon aft 1/Vn?
& Are there lagoons or storage ponds an site wbicb need to be pievpaiy closed?
t Mrft ameoens and/or yloldlne Pondal
9. Is arw* r d fiwboard less than a&gtrate?
Freebastd ($): JAVM 1 Lagaaa 2 Lagoon 3
2�
A Is seepage observed from any of the sbudma?
I L Is erosion, ar any other threats to the integrity of any of the stsuman observed?
12. Do any of the sbuctwu need
(if any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do may of the arucam lack adquame markers to idsatW start and stop pumping levels?
Waste Aeolieation
14. Is throe ObysicaI evideaoe of over application?
. (If is excea of WMP. or r=ff entering/waters of the State, notify DWiy
15. Chop type ��
16. Do the active amps differ with those designated is the Animal Waste Management Plan?
17. Does the facility have a lack of adeq= acreage for land application?
IS. Dom the cover crop need kgwvc=tnt?
19. U there a lack of available irrigation
Cjtrdfied FacOitles Daly
20. Does the facility fats to have a copy of the Animal Waste Management Plan radily rwar7sble?
21. Does the facility flail to comply with the Animal Waste Management Plea in may way?
22. Dos record keeping nod h pmvoment?
23. Dom facility require a follow-up visit by saw mgmcyl
24. Did Rtviewcffhq e w fail to d� rt viewfmspection with owner or opeaW in chargert
13 Yes wo ' ' •
13 Yes VINo J
D Yes M No
Yes PI No
Lg+ooQ 4
13 Yes ® No
© Yes la No
;$Ya p No
13 Yes ®No
❑ Ya 12 No-
E3 Yes 13 No
(] Yes ,D No
E3 Yes )8 No
D Yes IQ No
13 Yes JO No
0Yes ®No
El Yes *0
E3 Yes ® No
E3 Yes ,R No
Commeatsto q ' '� TJpi(] ^.J '- �^ e�lLYor�y,lQ.M�UI71�61Foii9 i Wan ay.� �t s �
Useyil�s�mgs:of.facilty:,tn bettrr;�laia situa�cros ;�nse oaal PeBes as; _ � �°��� „ :;, :..Ya
Reviewrer/lnsgector Name.
FtmwerAnspector Siguattrr -� Date:
#-r' DVWOA of PAZW Quality, Wam QuaUty Ssrsioa, Facift Atsa"um Uxb 11/14/%
Reviewrer/lnsgector Name.
FtmwerAnspector Siguattrr -� Date:
#-r' DVWOA of PAZW Quality, Wam QuaUty Ssrsioa, Facift Atsa"um Uxb 11/14/%