820303_INSPECTIONS_20171231

NORTH CAROLINA
F�
Department of Environmental Qua!

AL
Type of Visit: O-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral 0 Emergency 0 Other Q Denied Access 1I
Date of Visit: LLB-J Arrival Time: p� ;$� Departure Time: County: Region:
Farm Name: (i(% T tti'I1'r Owner Email:
Owner Name: r` �[ c�iG�! (,(J 1 /� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: �G�u;� we lb Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
!line
Design Current
Tlesiga`
Current
Design Current
'`
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
La er
Non -La er
Dai Cow
Dai Calf
Wean to Finish
Wean to Feeder
'Feeder
to FinishairyHeifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
`= D , IYoul
Layers
Ca act
1?0
Non -Dairy
Beef Stocker
F
Farrow to inish
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turkeys
Other
�� `
Turkey Pouets
Other
Other
DiscliaEges 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 ®.No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No
[:]Yes allo
❑ Yes [2_No
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - D JDateof Inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ 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: `r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31j 3 J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
KNo
❑ 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
B No
❑ NA
❑ N E
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E�,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
`
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[g-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 / a❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12_ Crop Type(s): C13tr ZLIJ , �r r�
7nn i J
- -
13. Soil TYpe(s): Wa� ><c� De^Q_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B No [:]NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [. No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑'NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ELNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No
23. If selected, did the facility fail to instal] and maintain rainbreakers on irrigation equipment? ❑ Yes E&No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faeili Number: - 3 jDate of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ". No
a
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [RNo
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?
#): Ea Aiiin aoyXES 4'nsw__ and/pr•a©y additi©ual reearni
17
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes k] No ❑ NA ❑ NE
❑ Yes [. No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes B No
❑ Yes [a No
[:]Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
r 74 Ajar' ra r ✓ � )/+,ru
/ v'a %i'► � 1 `' D�.�' �'"U. --� � �u.l�o� I`t D� �: �" � .TTi � a �� r_ �`%' �--�_ C r� �p Lu i �.d �c�l
'�-o V 0 J r
Reviewer/Inspector Name:
Reviewer/Inspector 5ignatur
Page 3 of 3
Phone:/v 303 G rL5—1
Date:
T
21412015

Type of Visit: ompliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
[season for Visit: a, routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency Q Other Q Denied Access
Date of Visit: /lj Arrival Time: ; p Departure Time: County: fpz Region:
Farm Name: IV L u) Owner Email:
Owner Name: C— ='06&,, �LLUid W t Phone:
,'Mailing Address:
Physical Address:
Facility Contact: a f z- p Title: Phone:
Onsite Representative: ���.c�� Integrator:
Certified Operator: �QU� z� (� Certification Number: 6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Cur4rent Destg�Current Design Current
""S nee. Capacity PopWet,Poultry Cap c►t} Pop Cattle Capacity Pop.
_.
Wean to Finish Dairy Cow
'" DairyCalf
Wean to Feeder �y
Feeder to Finish 3�d DairyHeifer
Farrow to Wean Destgn Current U Cow
YaJ,
Farrow to Feeder D P.oul Ga act Po -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Oflier_'' TurkeyPoults
Other Other
71�_T
Layer
Non -La er
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b, Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
fK No
❑ NA
❑ NE
❑ Yes
C&No
❑ NA
❑ NE
(1
Page 1 of 3 2/4/1015 Continued

Facility Number. - © Ds ection: //—
Waste Collection & Treatment
�• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2�No ❑ NA ❑ NE
a. Ifyes, 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): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
S[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
a 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?
0 Yes
10 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
UKNo
❑ 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
JoNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
JR No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraalic 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): //.V "-fk
13. Soil Type(s): /�Grrvt
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[.No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes FA No
to—
❑ Yes Jallo
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes ELNo
20. Does the facility fail to have all components of the CAWMP readily available? I f yes, check ❑ Yes �No
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement`? If yes, check the appropriate box below. 0 Yes ®.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:)Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Cj No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes Pt No
❑ NA
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 21412015 Continued

FaciliNumber: 0L - � jDate of Inspection: O i7E7
f 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [allo ❑ 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
pen -nit? (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 E!No ❑ NA ❑ NE
❑ Yes Eg-No ❑ NA ❑ NE
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [,No ❑ NA ONE
❑ Yes []-No ❑ NA ❑ NE
❑ Yes E-No
❑ Yes 59 No
❑ Yes O-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #I): Explain any YES answers and/or any additional recomtaendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone:
Date: ! �� � CD
Page 3 of 3
21412015

I Type or Visit: ®'=0utine
liance Inspection O Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral O Emergency O Other Q Denied Access
Date of Visit: t, Arrival Time: Departure Time: i County:tS
Farm Name 4�� ��4 [� G Owner Email:
Owner Name: Gib ,) ��Ll�! `L� ,� Phone:
Mailing Address:
Physical Address:
Region 91 �
Facility Contact: 1_}1 t 4Title: Phone:
Onsite Representative: IN Integrator: LIK
Certified Operator: /D6r ` Certification Number: IZFZ-"5
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
_Capacity
Current Design Current
Pap. Wet Poultry Capacity Pop.
JLayer
Design Current
Cattle Eapacity Pop.
Dairy Cow
Wean to Finish
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
j;
n
D . P.oul Ca aci P,o
ILavers
Dairy Heifer
Dry Cow
Nan-Dan
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
I
Turkeys
-Turkey Poults
10ther
Other I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EJ-N� NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[3-Mr- ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[3-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[EI-NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Or -No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
-E] No
0 NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

IFacHity Number: - Date of Inspection:
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 E2-X9_ ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): �T _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes [ "'U ❑ NA ❑ NE
❑ Yes Q❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
3-9o-
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]" o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�-
Q'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of%Wind Drift ❑ Application
Outside of Approved Area
f '�{+� ��•
12. Crop Type(s): l LAN
13. Soil Type(s): n G0
RA �V I ��. D✓1
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
EJ'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements
❑ Yes / No
❑ Yes 1=J 1"o
❑ Yes [rNo
Yes E No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? []Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes d No
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facifity N jDate of Inspection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IR lqo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [0_d6'_ ❑ NA ❑ NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey ❑Failure to develop a POA fof 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 D- -o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EaM ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q-1"o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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)
31Do s . bsurface tile drains exist at the facility? If yes, check the appropriate box below
Q Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [3-No ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
es ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes lJ 'vo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [3 Yes [3- -o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E],N-o [] NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: U�l 'i ')
Date:

L
Type of Visit: omp 'ance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: r Arrival Time: Departure Time: County: Region: t'
Farm Name: Owner Email:
Owner Name: d t 2G Phone:
Mailing Address:
Physical Address:
Facility Contact: 4l
Title: Phone:
Onsite Representative: Integrator: ' jh
Certified Operator: O t al Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
g
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P.oul
Ga aei
Ho
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
urkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Q Ne— ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [3 No [r KA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes [:]No [D A ❑ 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 ]o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes <o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

f Facili Number: - Date of Inspection: 55-
1'
I.
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2
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
E+Ko ❑ NA ❑ NE
[:]No [D-NA ❑ NE
Structure 6
❑ Yes �o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
000 NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3'go— ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
[;-Ne- ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ff5o ❑ 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 ind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &-t' CMG
13. Soil Type(s): 66 y fV p RZ. _
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑i 'l�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑' Flo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
❑'1tlo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ETNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ <o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
<o
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0N ❑ 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 [Zf-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Al
[Facility Number: - Date of Ins ection: C/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�-N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [�JIQo ❑ 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 [� o ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E:14o ❑ 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 GAWMP?
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?
S(u�f�SusVy- s iK-�y
6'oocL) r.Ps
Reviewer/Inspector Name
LCts
❑ Yes io ❑ NA ❑ NE
❑ Yes G3<o ❑ NA ❑ NE
❑ Yes [2 Ko- ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
g�rNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Phone: Lk�� _3
Reviewer/Inspector Signature: l 1� Date:
Page 3 of 3
21412014

R f 0 s 1-1K.4,P1
Type of Visit: 1 �C Lance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit: - Z. Arrival Time:I f f tv r I Departure Timer V V County• Region:
Farm Name: p't�, QL f [, LLw `-- �(u�.�iJ Owner Email:
Owner Name: PPhone:
4
Mailing Address: ' /� 10 +6 9to-
Physical Address:
C
Facility Contact:ff—lyTitle: Phone:
Onsite Representative: Z Integrator: % �p
Certified Operator: �.IU �„� 910 � Certification Number: 1 76�5
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
..
- Design
Current
Design
Current
Design Current
Swine ,� -Capacity
Popes
Wet PoulfCapac%ty
Pop.
Cattle ' Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
"
'
DairyHeifer
Farrow to Wean
Deli-
Current
Cow
Farrow to Feeder
Dr; �1'oult .
-_s
„ Ca :aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
21 Other
I_
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes QjNQ� ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance than -made? ❑ Yes ❑ No LaAA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No 0-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)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No
❑ Yes L!� ""
❑ Yes Q ""
L-J1VA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0>o--'❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ' R
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IYj' o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�❑ 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 Ga.Ai,T- ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [��ier� ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [5,Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q3,No . ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes Ci-ro ❑ 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 D ❑ Application Outside of Approved Area
12. Crop YP T e(s): C- W�
dlf V1 1��1A� [.ice d lit
13. Soil Type(s): 8 L C Dv\
14. Do the receiving crops di er from those de ignated in the CAWMP?
❑ Yes
[21<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ELNe—
❑ 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
U 1 p
❑ 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 CEI<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [D o ❑ NA NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes On< ❑ 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 [9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes La"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: z 2 T1Date of Inspection:
Jf
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�9 o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [].Add ❑ 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 f ErNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 02 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: -
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ Yes Etd�'" ❑ NA ❑ NE
❑ Yes Lrkvo ❑ NA ❑ NE
❑ Yes ED N;6" ❑ NA ❑ NE
❑ Yes'" ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
Io❑ NA ❑ NE
D>6/❑ NA ❑ NE
LamX'b0 NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
21412011

Type of Visit: GrCompliance Inspection O Opefr tion Review O Structure Evaluation O Technical Assistance 1
Reason for Visit: eRoutine Q Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access 1I
Date of Visit: Arrival Time: Departure Time: ',35 County Region: Fft
Farm Name: �p; iT Owner Email:
Owner Name: �(,r�r��p pL Phone:
Mailing Address:
Physical Address:
Facility Contact: j\mot u5Cc,N Title: Phone:
Onsite Representative: Integrator: MuRp h2i Bk'wfo
Certified Operator: QQ„ \ A„ DPW Qm L Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
s
Design Current
C& "y
• pacEty rs'Pop
W.et Rou[
La er
Non -Layer
D . Point -
Layers
Non -Layers
Pullets
Design
Capacity
Design
Cif aci
Current
Pop°:
Current
Po
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
Cow
Nan-Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Finish
Wean to Feeder '
:
Feeder to Finish
U b
U
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
_
�_,_ -"
Turkeys
Turkey Pouits
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?li,
❑Yes
[Io
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[glNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: IC 31 t a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [21 o ❑ 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): I Ck C1
Observed Freeboard (in): '_1.V %— '�) U
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2'Nlo
❑ 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
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[grNo
[DNA
❑ 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
hffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cc,QnQvt ram., s15
13. Soil Type(s): ` - 5 ol S i,ior-,
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [�Io ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E21'1�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [g'1Qo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ kNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑Tlo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
Q'INo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[-]Yes
[D-1Vo
❑ 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 [4*"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 2No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EEfNo
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeflity Number: a - 303 jDate of Inspection: 3 f �
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [Z'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes D'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes [B/No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
O'No
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
dNo
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
Q'1Vo
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
[3'No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
[—]Yes
❑Ao
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
Q'No
34. Does the facility require a follow-up visit by the same agency?
[:)Yes
[j]-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: I C_AMP
21*2011

w
MS DVS S• 13111
Division of Water Quality
Facility Number j 30.{1 ®Division of Soil and Water Conservation
IiW
. Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: iEFRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , 4Y Departure Time: "5'0 County: �n fo Region: I �c
Farm Name: t -Tvrke7 I40fV_/M Owner Email:
� ��r�
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: WAY TTQ�Aa, Title: Cns,,, k„� Phone: &V--lp 3
Onsite Representative: 9 r ly &01322 Integrator: N__L
Certified Operator: 191V I Dail Certification Number: 13 Sas
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current DesEgnCurrent Design Current
Swore CapacttyPop Wet Poultry YCapacity Pop Cattle Capacity Pop.
Wean to Finish a er IDairy Cow
Wean to Feeder Non La er Dairy Calf
Feeder to Finish �}$ t Dairy Heifer
Farrow to Wean ^�, Des gn�Curreiit Cow
Farrow to Feeder D Poul Capact Eo '. Non -Dairy
Farrow to Finish : °'nti Layers t Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets 113eef Brood Cow
N
4l Turkeys
Other Turke 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 [a No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [3 No
❑ Yes qNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: S13/11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
tRNo
❑ 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): 01) - - a 0,
Observed Freeboard (in): !--
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
f>_�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
CS�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C3�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�[No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'! if yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C -Wheal, , 301helw - -
13. Soil Type(s): (OOL41b1fo I S VOfi . IVDTD(K I ► t) tl, LOaS
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
pta�f S
❑ Yes
ba No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes J�j No ❑ NA ❑ NE
[:]Yes E ❑ NA ❑ NE
❑ Yes f5a No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If ycs, check the appropriate box below. ❑ Yes [SINo
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[RNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: a -.10 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ca No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail. to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
[]Yes ® No
❑ Yes ❑ No
151
❑NA ❑NE
NA ❑ NE
❑ Yes E5� No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes LS�No ❑ NA ❑ NE
❑ Yes
5 -No
❑ NA
❑ NE
❑ Yes
C@ No
❑ NA
❑ NE
❑ Yes
�' No
❑ NA
❑ NE
❑ Yes
C' No
❑ NA
❑ NE
Comments (refer to question an Explain an y additions .recommendations or`any ottiler comments. irl
Use drawines orfacwtv.to better exulain situation fuse addthonaVnaees_as necessary)..
-7` ����e f) a 00�)� -T aid bac&r to f of f Top ji Kv as s--Pei
or 1 yh-t- `f is s ,�r anf ir�� fCo Od
r� i Peas A ; sla
QGt7� a e w� d/1. rl o °f�' rzlf 2. L
Wh e Irry iP f °Jr,
^
C orn coo 's -fo �r .S d me_ as r� kP� n a h�a n�herP,,o flri
y
Rec@n& are {rljootts hafE .
7- Pjea:--Gx cracks b&4n-iot' oe h ovlPs ne4 ocal i - net ter kj
ay � .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
ann Schne 1 er
Phone: //��-1�J—� 3L10
Date: AV `3 C-)0
/4/2011

Facility No. T�-303 Farm Name
Permit , / COC
+ 'M-
Pot tO�t L d, Date
S (Rainbreaker� PLAT Annual Cert )
r I B3 f
sjr-T-
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Slud a Survey Date t
Sludge Depth ft
Liquid Trt. Zone ft
5 <
<
Ratio Sludge to Treatment Volume
C05�i W.
DesignActual
i�r�■ir1iT��1��■�����
1 Design Width
Width.-
Soil Test Date
pH Fields
Lime Needed
Lime Applied r+- mft�
Cu-I �n-
Z
Needs P
Crop Yield
Wettable Acres c�
WUP �^
Weekly Freeboard ✓
1 in Inspections ✓
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
a b or incinerator
Morta ecords
Waste Analysis Date
.0 Day-
.0 D.
6�
MA ' 1:r O"l-
II���i.1r���.'r���■
i,wi±fi F1uDlMlil
%I
? .,�
'
.�
..
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 111311c) Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-1 3000= 213 Ib/ac

c
Type of Visit -0 Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a---�i� Arrival Time: * Q Departure Time: County: S
01
Farm Name: oQ �rBI -Tvr �[-P, AQ Owner Email:
Owner Name: t Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: BQQ* vefflC j-j Phone No: D�— lao2l
Onsite Representative: P Integrator: ' {�
t� ��
Certified Operator: P00 UQI _ Operator Certification Number: 17 g;) T
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: = o = , =
cd
- __ I III III ._. I..... I., U
Design Current Design Current
Design C*urgent
Swine Capacity Population VI'et Poultry Capacity PoE. pulation
CattlelllmC►apacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder ❑ Non -Layer
❑ DairyCalf
CgFeeder to Finish
❑ DairyHeifer
❑ Farrow to Wean Dry Poultry''
❑ Dry Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish ❑ err
El Beef Stocker
N
❑ Gilts Elon-terr
El Beef Feeder
❑ Boars El Pullets
Beef Brood Co wl
. h . ❑Turke s
-
❑ I UN xt:y Poults
❑ Other ❑ Other
of Structures:
WE
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 ofthe 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 allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes RNo
❑ Yes �kNo
12128104
❑NA ❑NE
❑ NA ❑ NE
Continued

Facility Number: a —e3613 Date of Inspection �+
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes jjjrNo ❑ NA ❑ N E
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 153;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? JRYes ❑ 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 Wo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fiaPo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo
❑ 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
E" No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
'-No
❑ NA
❑ NE
Comm ents (refer to question ft Explain any YES answers and/or any"recommendations or any=ottier comments
Use drawings of facility to better explain situations. use additional pages as necessa n
g R ( r}) .
l
Re,%iewer/Inspector Name MAEEPhone: q
Reviewer/Inspector Signature: Date: �{'
/2128/04 Continued

Facility Number: Qa -303 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1;3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LWNo ❑ NA ❑ NE
the appropriate box.
❑ W UP El Checklists El Design El Maps 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 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
2T 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 nonnal?
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 1p-No
❑ Yes ❑ No
❑ Yes E,;�-No
❑ Yes §jlTlo
❑ Yes RNo
❑ NA ❑ NE
'RNA ❑ NE
El NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ No 19NA ❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
�JNo
❑ NA
❑ NE
❑ Yes
29 No
❑ NA
❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
7 sad j boo,) sfftto� Iaa), hiikzbat- rsjo - , yvI n eed -to 6e_
Th$e_ a er a I o swe_. ?xrey6ij a) -ire- i'tv de- waI1 06-
4eso* fo'm YVA f P U
5t p��e f �fi e fcCs� T`-� ► aV- -M3 . So i 1 war - Eqk 1� 4P
A lN� Wps 6L 6 rvaiL stO been NAP_ aooa A0 aol oa
Pie. 0* 9� p Ids S n :wlas; a[ 0-d . (_ Cr0 Dti'
� Y 9
r�, ha�-o seal ce, yjvs a tee[,
Page 3 of 3 12128104

- Facility No33` 0 Farm Name
Permit `f COC
V Qr l 6-A-el-S Date 104
OIC NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
34"m9k 7i
Lagoon
1
2
3
4
5
6
7
Spillway
a
Design freeboard
3
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
M
Soil Test Date
pH Fields
Lime Needed Of Z,T�
Lime Applied 3
Cu-1 � -Zn-1 7
Needs P
Crop Yield
Wettable Acres ✓
WUP
Weekly Freeboard
1 in Inspections z�
120 min Insp. .�
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
M
Soil Test Date
pH Fields
Lime Needed Of Z,T�
Lime Applied 3
Cu-1 � -Zn-1 7
Needs P
Crop Yield
Wettable Acres ✓
WUP
Weekly Freeboard
1 in Inspections z�
120 min Insp. .�
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
.f r_
_
��•�
"(I n
TOR
fang O
Verify PHONE NUMBER§ and affiliations
Date last WUP FRO -LwDy Date last WUP at faun
FRO or Far Records �o
Lagoon # i� �� ��{�} ly)-
Top Dike -3p0
Stop Pumpgy 48
Start Pump `}$ 3 3,0
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lb/ac
11%
o � 4 Err q�_Q� �
l
App. Hardware AP-w�j
c
LPeedrkt`1s-ef
a Do r hie
ODf wPilJ
1Pnal� CJW n41j

&L m s
Type of Visit EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O-Ko—utine 0 complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1-7-VJ '-O S Arrival Time: I: ,f0 Departure Time: /; S�` : County: Region:
Farm Name: [�t;, 1 �t-ss, -• %u"Kc //c Aare
Owner Email:
/
Owner Name: �pc.�;c:v� .be."f i Phone:
Mailing Address:
Physical Address:
Facility Contact: e-er /Wo r Title: 7c44 Phone No:
Onsite Representative: M—z- Integrator:
Certified Operator: gZ� ilat Operator Certification Number: `7 g8d (v 9
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = [ ="
Longitude: = ° ❑ I = W
Design
Current Design
Current Design Current
neCapacity
F
Population Wet Poultry Caacity
Population Cattle Capacity PopulatiWean
to Finish
❑ Layer
❑ Non -Layer
❑ DairyCow
❑ Wean to Feeder
❑ DairyCalf
® Feeder to Finish
DO
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
ElBeef Feeder
PE113oars
❑ Pullets
❑ Turkeys
❑ Beef Brood Cowl
Other
❑ Other
❑ Turkey Poults
Number of Structures:
❑ Other
I
Discharges & Stream Impaets
/
1. Is any discharge observed from any part of the operation?
❑ Yes
2No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
D<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�A
❑ 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
E,] No
E] A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
L�<oo
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
El0
'No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

f
Facility Number: e — j 03 Date of Inspection V2 d 0%
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[`j`No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
LJ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: 445 i _ Lily L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36 30 ."
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 property addressed and/or managed
El��,
Yes
/�
L'� 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
3 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ 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 Drifl ❑ Application Outside
of Area
12. Crop type(S) (�'CVAJ - W k r « f - R e,1 ,-S
13. Soil type(s) Oc A L-,v AA /1fo a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EKo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
BNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
B<o
[INA
[INE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
Reviewer/Ins ector Name ' "' `''`j*
P ,. r�, 'K.t 5 Phone: 910, i/33,33a a
Reviewer/Inspector Signature: Date: 12-dj7--,0
12128104 Continued

Facility Number: $2, Date of Inspection 2-Gig 'O`i
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
ap ❑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 1" Rain Inspections
.,,❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes L7N//o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffNo ❑ NA ❑ NE
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 Issnes
❑ Yes
B<o
❑ NA
❑ NE
El Yes
2' o
El NA
El NE
❑ Yes
t,., NNo
ElNA
El NE
❑ Yes
UNo
❑ NA
❑ NE
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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes TN.
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
D o
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
12128104

— ✓ Wit.. a ._ . n—C c>,-7
Type of Visit ("Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit GnI—outine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: //; Departure Time: /,'S'O County: Y9&..l Region:/f!?
Farm Name: bOLF 1 R rDSdoq /" Y'.n Owner Email:
Owner Name: JF1d LIJ a Ij Phone:
Mailing Address:
Physical Address:
Facility Contact: 49 YGW V�koa Title: Phone No:
Onsite Representative: Integrator: otuyla& RIrn k&z
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ' = u Longitude: = o = ' = u
�_. Design
Current
Destgii" Current
IN-
Design Current
'
Swine Capacity
Population
Wet Pou
ElCapacity Population Cattle Capacity Population
❑ La er Dai Cow
yer ❑ Dairy Calf
❑ Dairy Heifer
D Poult �- ❑ Dry Cow
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
..
El Non -Dairy
❑ Farrow to Finish
❑ Layersc
❑ Beef Stocker
❑ Gilts
El Non-Layers
El Beef Feeder
❑ Boars
El Pullets
El Beef Brood Co
-3
Qther -
El Turkeys
4
❑ Turkey Poults
_
❑ Other
❑Other�Number
.
of Structures
......:...
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[^No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
,--,[�1A
3 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
El No
JA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
oo
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,B
o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

)F
Facility Number: - cjj Date of Inspection !1-p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes [R o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 1V o ❑ NA ❑ NE
through a waste management.or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [31 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�
9. Does any part of the waste management system other than the waste structures require ElB Yes �vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7 No ❑ NA ❑ NE
maintenance/improvement? ,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes lslvo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) coyhwl III b earl S
A `Tp-"
13. Soil type(s) G.A, _ L� AJ&A j,.-/ ka-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,�To
D oo
[3NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EKo
❑ 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
Reviewer/Inspector Name Kra 1 Phone: %. = , 333p
Reviewer/inspector Signature: &±ARee-� Date: 2-o$ • 2�ooS
Wage 1 of 3 1fV'16/U4 [.onunuea

l '1
Facility Number: -2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E10 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes E o ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design [3 Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0" ]rho ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I_7<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t-] No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
911o­
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0' o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
BIG-
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes D rKo ❑ NA ❑ NE
Other Issues
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
Els
,--�,�
L��,rro90
[I28. NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Ell� Yes
❑ 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 -?To
[] 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
[%'I�lo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
0�io
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0'l o�❑
NA
❑ NE
A'd ihonal Comments anN71 r Drawm
My
Page 3 of 3 12128104

V% Division of Water Quality \: ` ` { �
Facility Number O Division of Soil and Water Conservation j `�
- 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. -i Arrival Time: Departure Time: Imo` County. fl Region:
Farm Name: �' rol6s— 1 Ut lD F-Glr w"i Owner Email:
Owner Name: FAL._� Y 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Ieck SrVC Phone N aK5; �24
Ousite Representative.- �1,y W-A ti t lit' _ Integrator: PCRx LTC CL
Certified Operator: r l�C�l_X� Operator Certification Number: v
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = , = « Longitude: ❑ ° = , =
S CL C -r
Swine
Wean to Finish
Wean to Feeder
feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Norn-La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Dischames & 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
❑ Dair
y Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockez
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: �;
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 PNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes _yNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (� 0+
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Wo
❑ 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 El NE
through a waste management or closure plan? X v
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? Ayes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo
❑ 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 ❑ YesNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o
ElNA ❑ NE
maintenance/improvement? 5�1
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes qNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13_ Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
INo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
YesZo
o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
IComments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
1�ar_ area's o-nuspulS "C[0156� �n C1 CGi�/- ls `4
i t°SCCG�� I'>1 r. �C� `Fc� StQ 4c, �Cc �f f �tsz � n-('evi4nCL �v p
Reviewer/Inspector Name z )4E bLAM-1qD1Q Phone•�Axb _ 6
Re-viewer/Inspector Signature: Date:
12/2R/I9Continued

1
Facility Number: Date of Inspection 1 a
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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
*A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as Tequired by the permit?
❑ Yes
.NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
K'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
*o
❑ 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 Wo ❑ 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
P 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
09 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
1 c, Pj cer dF'. e ?�01
12128104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 1 o Arrival Time: ® Departure Time: County:
Farm Name, —ru. u OCR �7 (1l(yy"- Owner Email:
Owner Name: � t .nX� DbA Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact:CD k_?_ ' ' `� 1T� Title: i tCA, _ i]P C Phone No:
Onsite Representative: 6 �Integrator�{&rl S-Lj
Certified Operator: r Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = i = Longitude: = ° = i =
Design Current
�r
Design Current
Design Current
Swine Capacity Population
Wet Poultry A@ii city Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish CA
`x.
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry.
❑ Dry Cow
❑ Farrow to Feeder
El
❑ Farrow to Finish
❑ ers
El Stocker
❑ Gilts
N ay
Elon-ts ers
ElBeef Feeder
El
❑ Boars
Pullets
❑ Beef Brood Cowl
Off--; ,-
❑ Turkeys
x- _
Other
❑ Turkey Poults
❑ Other
El Other
p ;:Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[--]No
R§ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
-�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
U No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128LI04
Continued

Factli h. Nuniber:�Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
WNo
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard r
(in):
Observed Freeboard (in): 23
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
_[kNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ffrNo
❑ 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
VNo
❑ 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
9No
❑ 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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) CO rY1 - 0-LXN
13.
Soil type(s) C~l0 b Ys2 _ n 5
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
EtNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
�' No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No ❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
P5No ❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): I
4Q . L& v? f r �h .23 `'4v
• Q r iLe � L<.,�� ���e/�' lD� `�b S.c.�la�-c,,(��C' U><�.o-.�.
OYI C ij o
Reviewer/inspector Name KFSV A)T DAj ! Phone: '1O YJ 5 560L)
Reviewer/inspector Signature: A Date:
Page 2 of 12/2 Ind t""" inuod

Facility Number: --3rVZ Date of Inspection O%
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ INo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LK No ❑ NA ❑ NE
the appropriate box. ❑ W0, ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
LrJ Yes
eNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers
❑ Annual Certification
❑ Rainfall El Stocking El Crop Yield ❑ 120 Minute Inspections ��V/Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[14o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[TNo
❑ NA
El NNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[0 NoEl{�
NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
P<oo
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
5kN"o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
12No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes B<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes
[1allo
❑ 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
fNo
❑ 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
E3 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
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
��io
Ej' o
❑ NA
❑ NE
Additional Comments and/or Drawings:
r� t i j I j f / �
a piz fc3�.4w M LtS4 rp.-Cpy- d / i n ; �i q�Q f �r d- S 4o 1 nC ; CG -4-
t QQ_�n 6Q_ l .
Page 3 of 3 12128104

Facility No. �a-� Time In �� Time Out Date 91 wo�o
Farm Name► 1..Gs -�Integrator _ p.yj
Owner Site Rep
Operator No. d 3 Z
Back-up No.
COC � Circle: General or ES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
-
Farrow - Finish
Feed - F'
Gilts 1 Boars
Farrow -Wean
Others
FREEBOARD: Design 3 [l Observed r Ate.
Sludge Survey Q's `� Calibration/GPM I
Crop Yield Waste Transfers
Rain Gauge _ L✓ _ Rain Breaker +-/
Soil Test �J PLAT ✓ Wettable Acres �,o j0
Weekly Freeboard Daily Rainfall ✓ 1-in Inspection
Spray/Freeboard Drop `+hl c- qw, �1� c
La
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
Date Nitrogen (N)
Ilia h . -�
r •
i
1
r 6�

f2-
Za•�/
D9

®Division of Water Quality
Facility N.amber'r $02 303 Division of Soil and Water Conservation
Other Agency
Type of Visit 49 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % P Arrival Time: �� Departure Time: County: So,,,—p_sati1 Region: kc.�
�4
Farm Name: �LiE�� .• //00 1 do _ Owner Email:
Owner Name: �7`d A-, !_/o Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ( • L 1,j }' 4
Certified Operator: G 1 a.r V_ w . Q +a K.. f
Back-up Operator:
Phone No: 7l4 3��nnr� �nnY3'7
Integrator: Pt G I, i k V., S � ezKdC4rdL ___
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 1 = Longitude: E--] o E__1 ' =
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
}. ❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
717196
1 3 -1oc
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure M Application Field ❑ Other
a. Was the conveyance man-made?
Destgn >�,
Cattle Caln city:
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Nan-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: Ld
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?
�I
[X Yes ❑ No ❑ NA ❑ NE
[:]Yes
®No
❑ NA
❑ NE
IM Yes
❑ No
❑ NA
❑ NE
j
Doe
Do yes
❑ No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
21 Yes
❑ No
❑ NA
❑ NE
11/18104 Continued

r
Vacility'Number: p1 — 303 Date of Inspection 3 /7 -W
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? El Yes
❑ No ElNA ElNE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: - a
Spillway?:
Designed Freeboard (in): J 'a? '/ " r;2 D . `I " 5 J J0 41-K—
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [U 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 2 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes R1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Co 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?
l . Is there evidence of incorrect application? If yes, check the appropriate box below. C9 Yes ❑ No ❑ NA ❑ NE
N Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) �w�.a4<< Sou��ca�, S
13. Soil type(s) k o i4 , b 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
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
[M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
10 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U1 No
❑ NA
❑ NE
0- AC_ ^h*4 XJ Cy.D 7rpA^ n �V Appl! Co.+.UN
S T O i /('/n e C M 6{]'S kJ a- .t 7 [- C tV 4
irt4-o t-�.�
Reviewer/lnspector Name Q� r. ' {�� ` Phone: F/o L%z&
G-
Reviewer/lnspector Signature: Date:
12/28/04 Continued

r
;racility%Number: $: — 30P Date of Inspection Fi !7 ox
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes jA 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 appropirate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard CX Waste Analysis ® Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking [Xj Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U 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
[7No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2No
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
rtyl
UrNo
❑ 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
1 C No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
�iteiitsarid7i
/ ",Pros eoti• _ O.a G,- Vah"04 1C. ,
se—, 1I,- t' Sot � t r o+e i
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�alrt1C�cr�'C-' -,rc, tV.,.haCC a�cJ+_]
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12129104

-00-00 TllE 12:00 AM FAX K P. 01
L
f'�teium Sr.�►,��r�l
P. O. Box 349
623 Southeast Blvd
Clinton, NC 28329
Phone: [phone]
Fax: 910-,592-2849
FAX COVER SHEET
DIV-V E:
TO:
COMPANY;
FROM:
RE:
Nuinber of pages including cover Sheet:
'1'1ME.-
RFrIE ED
MAR 11, 2005
n � 1=avpy�yLLE REGIONAL OKE
FAX: -S Io q-P6 __ d 7 D-
PHONE:
EsXT:
MESSAGE
11-17S C+AY COMIdIMCATION IS INTENDED ONLY FOR THE USE OIL 'IE . INDIVIDUAL TO WHOM IT IS ADDRtESCUD
ANL1 M.It r-ONTATN TNIrORM9TION n[AI' IS FROPRIT'TARY, CUNT IDUNTIAT. OTt PlilvILGGIsD. 1F YQ1J ATiL NUT
'111H IN'TNDI':I� ItL CIFIF14T (0 t AN L:A�LOYL•L OR ACCENT R1:.Si'ONS1I33M FOR DELIVERING THTS
COM111iN1C',i'1ION '1'017M INTE-NUL:D RF.[=TPIF.IJT), YOU ARF 11FREBY N01I1IED -MAT ANY DIrSL?MINA-MON,
DNI RTI ICJI oK OR Ulm NO 01. II ITS COMMON IC N11ON IS STRICTLY PRol 1313=13_ TI FANK YOLIT

-00-00 TUE 12:00 AM FAX NO. I P. 02
March 11, 2005
Larry Baxlcy
D.P.N.R
Division of Water Quality
225 Green Street
Suite 714 Systel 131d.
Faycttcville, NC 28301-5043
Subject: Discharge notification latter for Turkey flogs LLC Farm, facility number'82-
303.
Dour Mr. Baxlcy,
This letter is to serve as written notification of the runoff to a field Glitch which
occurred at the Turkey flogs LLC: fa1ru, facility number 52-303, on the evening eF",41rch
4, 2005. T'lic runoff, which was called in on the morning ofMarch 5th, was the result of
an irrieation reel motor failure. The enbine failed date to a carburetor problem. Thb
failure causal the reel to stop retracting, which caused the wastewater to pond and runoff
i11to a field Glitch. The operator was onsite and noticed the reel had stopped and shut the
punip off. An wrth darn was constructed in the ditch to prevent the water from
advancing down the ditch. The; wastewater was then reclaimed from the ditch using a
trash pulup and land applied to a nearby sprayfield. The ditch was then flushed using
fresh water from a tanker trailer, which was also lard applied.
If you have any quostions or need additional information, please do not hesitate to contact
Me Ott [phone].
Sincerely,
0-evk
Clark Williams

Type of Visit W Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: G ' 6 ' Time: l o .sM
o'Z
Q Q Below Threshold
0-Permitted der 'fried © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ----- .--
Farm Name: _,.TYva......... ........................................... -------- County: �. � «�.t a1a .............. Fla........
Owner Name: .. ��e.� ? ._ .. _ _ __..... Phone No: •g/G?-. 3. 1 .A-* .....
Madmg Address: ....... N.... ....� _..-?Q3.g3_
Facility Contact: ....... Phone No: _____.. ..........�__ ..._-.
Onsite Representative: ,-_,_, T Integrator -
Certified Operator:._.,,-,- C_e Y25 _,_--- ... P {S �r .............. Operator Certification Number:
Pe
Location of Farm:
P-Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6d Longitude • ' 64
Swine
Wean to
Feeder
lG�r
Feeder to Finish
9;6
,
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
`_ � Nu�inber af,La;
❑ Non -Layer
Other
Total Des"M
:To
Dischames & Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, noti)v DWQ)
2. Is there evidence of 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?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier-. ... ...�.................... .............A.;q__...... .
Frecboard (inches): .Z 4
12112103
Current
❑ Yes [}W0-
❑ Yes 2Io
❑ Yes Q14o'
❑ Yes �fo
❑ Yes E No
❑ Yes R o
❑ Yes pll o .
Structure 6
Continued

Facility Nurnber-.,12— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement,
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PLAN ❑ Hydraulic Overload ❑ Frozen Ground
C ❑ Copper and/or Zinc
12. Crop type �� ,� ! /� Q T' i1,/n j�(r G!!.N Qt ) /1 L YJN
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ®-Afar
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [, No
b) Does the facility need a wettable acre determination? ❑ Yes ONo
c) This facility is pended for a wettable acre determination? ❑ Yes [g-+le
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes aNe
Odor Issues
❑ Yes ❑ No
❑ Yes P-K
❑ Yes
❑ Yes [9-No
❑ Yes [. W0
❑ Yes LJ Nb
❑ Yes [, wo
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes E}l
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [g-No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 0110-
Air Quality representative immediately.
Use drawings of fa ty. to better sttttattoas. lase banal pages as necessary) &field Copy ❑ Final Notes
Ar. Ae:y er Is ,,r1Nj ,,/A /f'fe, T,'m //&// /'-W-'cle 41s rece,'v,,7,j
telo
4e— ovC , t t •'e ��, An o f� e r 71�. e &/ ++/as /o
M/-.
Rag-Arr be:nj
"-1 //re NdsP;I%
fAe 04,1,;9
vaf �,ssPJ a„aI
4v; //
6e P lanlc,/.
TAe- 1°/ ,v YLtia/-
vas a,Plro/
er- Cur
u-'%/ 4e .fir,
df
stir 6ra�s.
xM�
ReviewerlInspector Name` {P / p Lary
ReviewerAkspector Signature:
12112103
Date:
Continued

Facility Number: 9,,2— d
Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
®-Wo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )U3F checklists, dpSignmaps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ WWe Application ❑Fr=ba�J_ ❑ Waste Analysis ❑ Soil Sampling
y-Ay 7 A;? j 0/.5--
24. Is facility not to compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
El -No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
8-Nb
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
©-No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
28. Does facility require a follow-up visit by same agency?
❑ Yes
EP�o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9Wo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
El*d
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
EjXes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0440
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
W-W
34. Did the facility fail to calibrate waste application equipment?
Gg'Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
U-No
Ej5t9ek gFarm ❑ Crop Yield Form ❑ lmfil
❑ ❑
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
3. Mr. lfes,'.sler is sv,�5 7�4dvr5A 4 al:tloree dv?d 4%S rv,`fe hei; Prsf 7Par'3
Reeords. He 1`7i."5 fd f'.',7J f4eA, an loon kA 0.0" "n 'A.' "Oes-1.s.'a,.,
-113' -Zs G4-1 pre5e-., e t/�.►i
J s c apr • c c� >` S.
# 3 S! yal �Qr�a c �rpl G � o "�p"7' �, c o �•, 'e '?Ad [ a f '` ra 1t rs/a.st[e
/die. Reg4er 31alyd -r h 1.S Trsa/ �..as-lc I0/6'7 'hay Se
4,:A �A,
4 e cw 0wne/`5,
.12112103

r
g ❑ Division of Soil and Water Conservation ❑ Other Agency
®Division of Water Quality
190 Routine O Complaint O Follow-up of I) V0 inspection O Follow-up of DSWC; review O Other
Date of Inspection 2
Facility Number
Time of Inspextion '7suCJ 24 hr. (hh:mm)
0 Registered 0 Certined © Applied for Permit © Permitted 113 Not Operational Date Last Operated:
Farm Name:.....�� - I.. ice. !- %� ... County: ,-...:�!9.... .............................................
....
Owner Name: ......... 1... • t!!,. ...,l�. jrr- . ............................................. Phone No: .......... e .......... s...........^ /C...I..., .................
FacilityContact: .. ...........i..Z........ ..1//� ... .. 1 E f.�.� ..... Title: ................................................................ Phone No: ...................................................
........
Mailing Address:....... d•.... �/ ( l ��GE' ... X .. 2���.�.................................. ..........................
.............. .......................-......................................
Onsite Representative:.......... o-z ....,1� � / ....................... Integrator: ................... -..................................................................
Certified Operator ,......... e¢f/1............ /,+Ylgl........................... Operator CertiFication Number:... ,(.�.:3�.............
Location of Farm:
Latitude 0' 6 " Longitude a 4 49
"a k Desk Current u " <Desrgn ' r Current Desigii
.Currents
2
:Swine =Capacity Papulaoa, -Poultry CapacityPopulatioti Cattle rv�Capat�ttp I'opufatfon�
✓%'. .la. A � a, n
❑ Wean to Feeder
� ❑ Layer � ❑Dairy
® Feeder to Finish
❑ Non Layer I E3-][] Non-Dairy
❑Farrow to Wean
❑ Farrow to Feeder
❑ Otherk�f fl
❑ Farrow to Finish
Total Design Capacity ti
❑ Gilts`
❑ Boars
�n k ,$
'�.Y r+ r a.rez 'ae'�'cz SSI. �'1«.t a
.':
�TMA
Nucyuxber,of Lagoons /'Holtliug-Ponds* ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
�-Gffi §i algae+. ry8' S r` f� "0. xV9rvFx^�!l✓ °%«! .. .. ........ ....... .. .. ..' f�' ,�(-. ik"S'rrv. ,y�i,
L2
h��up'C' ,i(9,o �
❑ No Liquid Waste Management System % hTv Rx"
General
1. Are there any buffers that need maintenance/improvement?
2. 1s any discharge observed from any part of the operation?
Discharge ori-inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in-aVntin?
d. Does discharge bypass a lagoon system'? (if yes. notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Continued on back

Fai-lity Number: --k
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes j] No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes f No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
VfNo
Structures (Lat7oons and/or Holdin.- Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
5"No
Freeboard (ft).- Structure Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
,
�Ij
10.
Is seepage observed from any of the structures?
❑ Yes
$M No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
Yes
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes ANo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ......eltf.114r �s7c�s<✓�. �Llf�._ lS._ .... _............. _ ._
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
ONO
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
10 No
18.
Does the receiving crop need improvement?
'Q Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
JV No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
ErNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ANo
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑.No
24.
Does record keeping need improvement?
Al Yes
❑ No
Cozzurienis`(referio questtoo Explain any YES: answers and/or any recommendations'or any other comments: 4
Use drawings of facilrtyto.bet exv n situations. (ai.pages as necessary} � ; , �
Cuse addtttori
1>7 �,�>�,�.�✓� a� ;��i,�,.,,; ,mac �,��,rr6y i���f ��
Reviewer/Inspector Name
Reviewer/Inspector Signature: �0 1 Date: % ~
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

vision of Water Quality`
Facility Number _� �3D 0 Division of Soil and Water Conservation a2ve!(,0477f
Q Other Ageacv
Type of Visit 016ompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up Q5 t�L eferral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ' �(� County-: L '`� _ Region: T ✓�
Farm Name: Da,,L r >�7*4"wrter Email:
Owner Name: LC%x�� l� }l��r����a� L _, Phone:
Mailing Address: ��G � � L� S � %� �✓t � �`1 S Lei �/ G". /ff�
Physical Address:
Facility Contact:
Title:
Onsite Representative: //
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
/Phone No:
Integrator -
Operator Certification Number:
Back-up Certification Number:
❑o = =�� g ❑n =,
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
10 Feeder to Finish
L (.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges g Stream Impacts
1. Is any discharge observed from any part of the operation"
Discharge originated at: ❑ Structure ❑ Application field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy_
❑ Beef Stoeket
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures: E
d. Does discharge bypass the waste management system? (If yes. notifv 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
ONE
❑Yes
❑No
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
J[ No
❑ NA
❑ NE
12128104 Continued

11
Facility Number: 8' —_3031 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes ❑ No ❑ NA aNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA [9NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): AVIL
Observed Freeboard (in): JQO
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA W-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 RNE
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 RNE
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 f94IE
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 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ 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
ONE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
E3NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ONE
l� Z-� cc1 i�1�0 ,
Reviewer/Inspector Name (�1�-� Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

F
Facility Number: — ZJ Date of Inspection —lam O
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 [3NE
the appropirate box. ❑ WUP ❑ Checklists Design ❑ maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ,Z Yes ❑ No ❑ NA Z N1✓
® Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[0 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
14 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[RNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
PQ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
fR 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
❑ NA
ONE
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
Cl NA
5� 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
[KNE
33.
Does facility require a follow-up visit by same agency?
KYes
❑ No
❑ NA
❑ NE
✓� on 17!`l� iW `�:O/+ �� S��j rt /l i[� /(JCIIL / C �fY.7�O
i If Ina Yr a ale+;:i,
12/2&04

I(
1�0 tatvision of Water Quality
Facility'Number � � �7rj 0 Division of Soil and Water Conservation.
0 Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
ollow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r t7 Q County: Region: Q'
Farm Name: rX #P2 FA/4b Owner Email:
Owner Name: ��CLL / d-' CYJ� J 1�2�. Phone: 2za C2220 - 0�3 ai3l
Mailing Address: ��S /`�C �� �a57L e'yl C-� i / Alt
Physical Address:
Facility Contact: - r�nY� ��%L _ Title:
Onsite Representative:
Certified Operator
Sack -up Operator:
Phone No:
Integrator:
Operator Certification dumber:
Back-up Certification Number:
Location of Farm: Latitude: 0 n E J ET
Longitude: [� ° [� g [� ,;
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Nan -La yet
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste inanagement system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [-]No ❑ NA ®NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
a NE
❑ Yes
❑ No
❑ NA
KNE
12128104 Continued

Facility Number: — Date of Inspection y 1;7 �
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA R] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA X1 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 [0 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 KNE
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 RNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA [ENE
(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?
It. 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.)
,g PAN SPAN > 10% or l0 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
®NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
(ENE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
❑ No
❑ NA
(ANE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
1K NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
U.NE
V a oVerzPPl-; c-,&, o, OP-jp,-� by INDre o7o on �oy6�d s
a4l o e2 —6 f d r D Si7ziUz-vi- w; hdoul, lugs �zz.,01i
Dn s �y�Y�, 6--cause 7 k '5 3 o d07
prrept'.� 4arc--1
Reviewer/Inspector Name r . • Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: _T03 Date of Inspection l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [j No El NA El NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. X Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking JACrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA RNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA [9NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA [2 NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA [Q NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA ❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
CK Yes
❑ 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
❑ No
❑ NA ONE
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 Revi ewerA n spector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
(K No
❑ NA ❑ NE
ddthana! Comments `andl4Drawings t'
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7 b
T-DpWeil
ot C ej,,,,C r 1 l
Or�'1 uh Ca7'�fln- ��It1Jrr�'c asril2�r {� Ile Fr!'S0n- f ee?e?/ ��-
LIJ061 W;J1 ,be sevl-M1`moor .Ia*-t�
'(FYI e ;�P 1� 't-A e ij vvT R d-$ j r? Tit r P�rl�* rwd 4�rt • o- J6 A�a.fc
,��dvG � �r`�r � 4�%fit /%%r ,�a L i �S u .t1cu..i Gir(/��r p��h ,s �� % � a� cf i1 I�o:i•►
�176 4f%r°Y'L"f»�ifi� St�JzsG �`�i'A��e'3 � - 12128104