820314_INSPECTIONS_20171231

-.Ado
NORTH CAROLINA
Department of Environmental Quaff

F
i ype of visit: vAA--omptiance inspection v uperation Kevtew V btructure tvaluation V i ecnnicai Assistance
Reason for Visit: G rcoutine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3a Departure Time: /; County:&.0L S aK Region: I "�
Farm Name: �� Z "CR-f D ,\ {' `'( Owner Email:
Owner Name: 1` p �wr ���+t �l .! c4U� s l Phone:
Mailing Address:
Physical Address:
Facility Contact: Oft, s 3 n.*^ GU t'-a Title: Phone:
Onsite Representative: li Integrator: m 6 Sacs
Certified Operator: _1h o11J Q 5 I A.G(t Son Certification Number: 25 Z5 z.
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
57
I
Wet Poultry
ILayer
Design
Capacity
Current
Pop.
I
Design Current
Cattle Capacity Pop.
Dairy Cow
[Non -Layer
D P,oultr
Design
Ca aci
C•nrrent
P,o
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
2,'7 00
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Layers
Non -Layers
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Rallo ❑ NA ❑ NE
[:]Yes
[]No
En'NA
❑ NE
0 Yes
❑ No
[31�A
❑ NE
❑ Yes
[:]No
[:]Yes
EfTNo
[:]Yes
dNo
[T]NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

FacHi y Number: P
# 9 - 3 / Ds ection: t
WN ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EDAl6-- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q-N-K ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): — IC? 3 g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [L]--go- ❑ 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
[31�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
HJ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
Q o
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
�o
❑ 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 Acceptabl(e(Crop Window ❑ Eyi nce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): M . L l � 8 � IU( �c f�f ff s-G D
13. Soil Type(s): A/o(3-D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZkN6-_ ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes l `• -,N'o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [t.<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes [ c]. �o ❑ NA ❑ NE
[:]Yes �o [DNA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Erl�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [-] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fl:]"�o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FacititY Number: - J tj Date of Ins ection: / /'t
24%bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [.-N—o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑�I o�❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E] o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E7rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Gj-Ko ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes 0'tqo— ❑ NA ❑ NE
❑ Yes
[�'No
❑ NA
❑ NE
❑ Yes
[Z_Ne-
❑ NA
❑ NE
❑ Yes
NA
❑ NE
Comments (refefAM question#): Explain any, YES answers and/or any additional recommendations or, any other comments ;
Use drawings 44Hlty4o better explain situations (use additional pages as necessary,):.
cQ 3 e—&, 6 c­, r- 3- l3 -- /6 � _ � 2y �d 2-10
C-a( cqb—`3O&-- 66s(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�IIjf
�Li �Vr✓1 PhoneC'(K)
c r Q
Date: 1 MCP4U
2A 0I S

FaCili Number Division of Sot! and Water Conse
ivtston of Water Resources � `� _
ty - .. rvation
Q• Other Agency _.. r
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: leRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:_
Farm Name:S �*1.-f a Owner Email:
Owner Name: p Alt-a—nLero.1 Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Cu L41 3 1—_26t ZL( ,<<Gt Title: Phone:
Onsite Representative: �( Integrator: `I— i �_�(,�2
Certified Operator: /10lka_S � �G.LCl O `^ Certification Number: ;7,.5 ZSZ
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current W1.":.
Design Current
Swine Capacity Pop. Wet Poultry Capactty Pop. Cattle C►apacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish > p
z
Wes,: Des'ignCurrent
Dr. P,oul @a act '� Pn
Dairy Heifer
-
FarrowtoWean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
jBeef
Stocker
Gilts
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
_
Boars
Other
11 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 DW R)
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 <o ❑ NA ❑ NE
❑ Yes ❑ No ❑'l�A ❑ NE
❑ Yes ❑ No NIA ❑ NE
❑ Yes ❑ No
❑ Yes �o
❑ Yes Z"No
�J NA
❑ N E
❑NA
C]NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facuity Number: - Date of Inspection:
_Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g;j_No--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D-NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �lo ❑ 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
E5'1�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[]'lq-o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[J<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
r7rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
el No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F -1i<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 Wi ow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
II�� �a
12. Crop Type(s): �1 q tit -p ,J e6�-AttLA 5 6o & v o
13. Soil Type(s): � )a & 10
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W�To ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo 0 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2'1 0 [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q'go
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eno
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�r_No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�fNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilih' Number: jDate of inspection: ,/t
2�. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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:
2b. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Duo [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Gj-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
3 3,6 3.5 qq 7v
Reviewer/inspector Name: b`I
Reviewer/Inspector Signature:
Page 3 of 3
❑Yes J 10 ❑NA ❑NE
❑ Yes [2No ❑ NA ❑ NE
❑ Yes E-Vo [] NA ❑ NE
❑ Yes ET -No ❑ NA ❑ NE
❑ Yes
[T No
❑ NA
❑ NE
❑ Yes
Eff"No
❑ NA
❑ NE
❑ YesCa"'No
❑ NA
❑ NE
Phone 1� "l-` �
Date: LfA
21412015

(Sd
9W
Type of Visit: &70utine
lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Complaint 0 Fallow -up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: u d Arrival Time: Departure Time: f County: .� Region:
Farm Name: a C br. F—a vU Owner Email:
Owner Name: 'O Phone:
Mailing Address:
Physical Address:
Facility Contact: CLAd cLY-W r . Title:
Onsite Representative: U
Certified Operator: j RpM.ta 5 �: S'a h s u - 1
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: M I— S
Certification Number: Iks
Certification Number:
Longitude:
Design Cunreat.,Design Current Design Current
Swine
Capacity Pvp. Wet Mulw_Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -Layer Dairy Calf
Feeder to Finish
=;b ... Dairy Heifer
Farrow to Wean
Farrow to Feeder
p0
.. .Design Current Cow
D . P,ault , 'Ca aci Pao P. Non-Dai
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
ML10ther
Other
Discharges and_ Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ©-Pd6 ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [—]No Eg-KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [2�<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 DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3�`No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ETIN' o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

lFacility Nun4ber: - Date of Inspection:,�,nr.
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):
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
[�,l�lt�❑ NA ❑ NE
❑ No �A ❑ NE
Structure 6
❑ Yes NA ❑ NE
❑ Yes To ❑ 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 [j3<o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F�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 Lij.NV ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ea4dff ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes UT<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 Cro W' dow ❑Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crap Type(s): ti At uI gy4_ Go-(& C 18 ��b 0
13. Soil Type(s):
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.
❑ Yes
LDrNo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
E�' o
❑ NA
❑ NE
❑ Yes
[I�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [� o ❑ NA ❑ NE
❑ Yes f No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes [2<o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesgNo
No
❑ NA ❑ NE
C] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

II
Facility Nuniber: jDate of Inspection:
ast TX
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes wo
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �o
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2* 0
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes [�No ❑ NA ❑ NE
❑Yes [R o ❑NA ❑NE
❑ Yes [a] No ❑ NA ❑ NE
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
[2rNo
❑ NA
❑ NE
Comrnents (refer'to question #): Explain any YES answers and/or any additional recommendations or any atheracominen05
ts ¢ �
Use drawings vf.faeility to better explain• situations (use additional pages as necessary).
3 �r3e7
Reviewer/Inspector Name: [ 4 Phone:
Reviewer/Inspector Signature: Date: vt
Page 3 of 3 21412011

I M s l A P K 13 4b
Type of Visit: Ericom ante Inspection Q Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: CF Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I'fj !j Departure Time: County: =n
Farm Name: Q � Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: P + t tOrWtlXt Title:
Onsite Representative: t l
�y
Certified Operator: OM011. 3 kv
Back-up Operator:
Location of Farm:
Latitude:
Region:
Phone:
Integrator: L,,.�L-t
Certification Number:s aS�
Certification Number:
Longitude:
Design Current
- -- _ =
Design
.Current
Design Current
Swine
Capacity Pop.
Wet=Poultry
Capacity RPop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
EJ
DairyHeifer
Farrow to Wean
-
Design
`Curren#
Cow
Farrow to Feeder
D ;poultr
La ers
Ca aci _
P4o
Non-Dai
Beef Stocker
Farrow to Finish
Gilts
Layers
Beef Feeder
Boars
jPullets
Beef Brood Cow
'.
Turkeys
Other�r".
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [?Qo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [—]Yes [—]No []J<A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑INA
❑ 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
[DNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[5' 4o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Wiste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less titan adequate? ❑ Yes FANtt ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ED>A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a - - o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [l]''Po ❑ 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 Rio ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes Q No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [To [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 ff 1"o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E2 "" [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E]J 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
iin�do rw/� JJ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1 'f ( U 9V -e e C.(� i �C•�7
13. Soil Type(s): T A a(y -v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (E " ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [1 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �io ❑ 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 CJNo
❑ Yes El"No
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[TNo
DNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[jNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [-]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
' No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3No
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
FJ'No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

I
Facility Number: 6 - A[ K jDate of Inspection: 6D u+i a.�� P
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ }4 f ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [344u ❑ 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 FZWb ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6�0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
pernut? (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 IS'"" ❑ NA ❑ NE
❑ Yes [n No ❑ NA ❑ NE
❑ Yes [ -1 o ❑ NA ❑ NE
[:]Yes f!rNo ❑ NA ❑ NE
❑ Yes
❑'No
❑ NA
❑ NE
❑ Yes
[�Vo
❑ NA
❑ NE
❑ Yes
[�f No
❑ NA
❑ NE
Comments. (refertb;question Explain any r an additional recommendahod or'
. ments'�
Use drawings of fai iiity to better explain situations (use addr#ronal pages as necessary).' ny tether comma # u
P-of 7
tsvn _P
D a
Reviewer/Inspector Name:
Reviewer/Inspector Signature: v
Page 3 of 3
D
3— p. 3, k- F3- `> k g Ya
Phone: [
Date: -_ J
21412014

Type of Visit: (.-&Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 006outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region-r_&
Farm Name: Qej�ia r�v�-•t Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: f,.� �,
Facility Contact: a QA-o t) U (- Title: Tr?tl Phone:
Onsite Representative: q Integrator:
Certified Operator: yi t, � �{;,L — Certification Number: ��,r-7_2
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current l)'esign Current Design Current
Swine Capacity Pop. Wet l'outt apacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
-Layer
Dai Cow
Dai Calf
Feeder to Finish
- - __ - .
_..._ Dai Heifer
Farrow to Wean
-
Design . Current D Cow
D ;Poul
Capa P;o Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts on -Layers
Beef Feeder
$oars Pullets
Beef Brood Cow
Turkeys
Ottrer TurkeyPoults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E2::W
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
❑ Yes
❑ No
['❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
EJN
❑ 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
�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes f!rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faciii Number: - Date of inspection:
Waste Collection & Treatment
;k Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L.l- ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No [KX_ ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t - 3 b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]-IGo
❑ 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
[]j'9o_
❑ 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?
ElYes
IiNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EKO
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑,P o'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[f No
❑ NA
❑ NE
maintenance or improvement?
l I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 1W 4 -( Ir y,.t I lC. CV 13 13
I )
3. Soil Types): No -
TC�
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
'L-j'"o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
Q'Wo
❑ NA
❑ NE
16. Did the facility fail to secure andlor operate per the irrigation design or wettable
❑ Yes
[ElNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[ErNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑11Go
❑ 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
9K0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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
[2*No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[3/No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:el
'I24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U�N� NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [4-Nh ❑ 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? ❑ Yeses ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E;'?Jo�, ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
� Igo--
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C3,We--j❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[2-No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[ o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2rgo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ T'
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ No
❑ NA
❑ NE
Comments (refer. to question ft Explain any YES answers and/or any additional, recommendations or any_other comments
� F
Use drawings of facility to better explain situations (use additional pages as necessary):,
CoAt b
L__vy VA-1
Reviewer/Inspector Name: V j
Reviewer/Inspector Signature:
Page 3of3
C".
CW3 13PJ��
Ph ,V6 -'�D ?�o
Date: 1. I
21412011

31y
Type of Visit: CKomp ance Inspection O Operation Review () Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 1 0"721Departure Time: C7 County: Region: IMO_
Farm Name: / I � ACKS�C, ,t, FA lint 5 Owner Email:
Owner Name: UA I f_ A ckso N - Ro hzAr o4,, z_,/ Phone:
Mailing Address:
Physical Address:
Facility Contact: C uR-V-TS 43 i1Rt"3QJ� Title: Phone:
Onsite Representative: III; rnz Integrator: C-mow Cmakir .a E liewaso Emrn5
Certified Operator: T& f-,q s /A - ok ksa42 Certification Number: a 5 a S;1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
--
Design
gn Current
Design
Current
Design Current
=Swine Capacity Pop.
Wet Poultry
Capacity
: Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Dairy Calf
Wean to Feeder on -Layer
Feeder to Finish
'a10 O ;A5'a-
' -
Dai Heifer
Farrow to Wean
Design 'Current
D Cow
Farrow to Feeder
Dr; 1'aoul..
Ca aci.
P,a .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
41
Turkeys
Qther'''
;W
Turkey Points
Other
Other
----I
=
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes dNo ❑ NA ❑ NE
Yes ❑ No [g-NA ❑ NE
❑ Yes ❑ No [0/NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [TVA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ 1"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [g"No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

A
Facifi Number: ViA It4 jDate of Inspection: Lj'1
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
[] No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
® NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier: #� _ # �✓
Spillway?:
Designed Freeboard (in): _ f ) S
Observed Freeboard (in): 9 54
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EVf 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
2/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
ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(TNo
' ❑ 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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo
[DNA
❑ 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): I Ix F-4•
CQ 0 1JACAL .4hcP1V,5
Z&A92UQA
13. Soil Type(s): elk -Q-;t 6,alJ6bogo `D- a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes
[J 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?
Rea uired Records & Documents
❑ Yes [3No ❑ NA ❑ NE
[:]Yes [�rNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[g'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3"'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2""No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No TN' A ❑ NE
Page 2 of 3 21412011 Continued

1
Facility Number: a. -3 ILI Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [0 No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q/No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [R'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[j]DNA ❑ NE
[—]Yes 1Q o ❑ NA ❑ NE
❑ Yes [2"'No ❑ NA ❑ NE
[:]Yes [5No ❑ NA ❑ NE
❑ Yes [TNo ❑ NA ❑ NE
❑ Yes 8 No
❑ Yes C]ErNo
❑ Yes [!fNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: a Date: ist is
Page 3 of 3 214120.11

(Type of Visit: Q9rrompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: outine 0 Complaint O Follow-up O Referral 0 Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: 110 ; County: Region:
Farm Name: i�l%t �iy—S� Owner Email:
Owner Name: aWte-�hone:
Mailing Address:
Physical Address:
Facility Contact: 0_3-L V4' . Title:
Onsite Representative: J 4A.-Pr
Certified Operator: ltkl fi
Back-up Operator:
Location of Farm:
Latitude:
Ph ne:
Integrator: wrr�
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current-.
Design Current
Swine
Capacity Pop.,
Wet Poultry .Capac�tV
"Pop
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
La er
-Layer
Dairy Cow
Dairy Calf
Feeder to Finish
0`
` -'
Dairy Heifer
Farrow to Wean
est
Dry Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
D Pouitr.
La ers
Non -La ers
Pullets
Turke s
. a aei
,P,o
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes io ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [:]No
�-
"N'AA ❑ NE
Q A ❑ NE
❑ Yes ❑ No [2- A ❑ NE
❑ Yes �fo ❑ NA ❑ NE
I —]Yes [ No ❑ NA ❑ NE
Page I of 3 21412011 CondAued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[Ej'1 A
❑ NE
Structure 1 Structure 2 Structure3 Structure 4
Structure 5
Structure 6
�
i
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
lJ 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
golgo
0 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
[llqo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Gj Ko
❑ 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
tit "o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ETNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ 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
y ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types . K�-�wI! � 1 L"t�t+w� / lj�6'�
13. Soil Type(s):
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.
❑ Yes
�lo
❑ Yes
03�<o
❑ Yes
[g- -o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [E o ❑ NA 0 NE
❑ Yes Do ❑ NA ❑ NE
[:]Yes g-< ❑ NA ❑ NE
[:]Yes E -3do ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other: _/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ��o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Q o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No E ZH ❑ NE
Page 2 of 3 21412011 Continued

Facili umber: - Date of inspection: IM
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3'0'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E j o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes U'<o- ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No R] LNB ❑ 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:
❑ Yes D 5-5 ❑ NA ❑ NE
❑ Yes 0ogo` ❑ NA ❑ NE
❑ Yes QIKo ❑ NA D. NE
❑ Yes io ❑ NA ❑ NE
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes E3 o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? []Yes To ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes gg-lqo ❑ NA ❑ NE
Coe drawings of fto qu ity question
better Explain any YES answers and/or any additional recommendations or any other comimenW
a(�;�
Comments refer to uestio etter explain situations (use additional'pages as necessary}. ;,, _ ,_.
/ ALYS l "-4. -.a- Z_ � 3
l P`y3
Reviewer/Inspector Name-, C_C t Phone: 9/d — 01y 3 7
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &1Romp�utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r 3� County:. Region:
Farm Name:. Il't. $Dn.r�'+'�' I Owner Email:
Owner Name: �rt C _ V _7 s�x"� Phone:
Mailing Address:
Physical Address: —�
Facility Contact:`;r►0 A�GSo•'— Title: —}-- Phone No:
Onsite Representative: z2&7.x d i2/ r Integrator: !/ • G f CUoj
r�
Certified Operator: X P- - s's'~' Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 ="
Longitude: = 0 0 I =
Design
C*urrent Design
Current Design Current
Swine Capacity
Population Vet Poultry Capacity
Population Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
110 Non -Layer I
❑ Dairy Calf
E-Feeder to Finish 19200
1
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Non -La ers
El Beef Feeder
FGilts
Boars
❑ Pullets
ElBeef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Imoacts
I . Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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
10 No
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —
Date of Inspection f
I � 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?
Structure 1 Structure 2 Structure 3
Identifier:
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /T-
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 0 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 faNe ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R1 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 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 R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) _j W m, Ij -
i
13. Soil type(s) 4M
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'13No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R No
❑ NA
❑ NE
( q #) Eiiplatn a andlor any recommendations or any,otherFcomments.
:.
6
`Use dra gf facility to better ex lain situatto ssuse, a
p ( ddttjona! pages as!necessary):_
t4 kr--
��ft-.� -pit r1, �,&-&M-440JA A!&
---
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 11 12128104 Continued

Facility Number: R;2-r 1 Date of Iaspectiao
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes J&No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists [I 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 I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J9 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
UNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
EZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
U 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J�LNo
❑ NA
❑ NE
s.
Additional Conimenti-aknd/or Drawuigs
Page 3 of 3 12128104

t
✓ 7I'au.S //- 2 3 -ZOo `7'
iTisiion of Water Quality
CaciU Numb;P i Ki -0515A Soil and Water Conservation
Other Agency __ . M
Type of Visit Q'Gompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Lb Departure Time: CD..2lJ County: ¢� J_0A/
Date of Visit: 1 /'��o -D Arrival Time: 9. / p ry � �_. Region
% Owt J a-_&onl � Owner Email:
Farm Name: I'
Owner Nampa-7 0 M J ks-.,v Phone!
Mailing Address:
Physical Address:
Facility Contact: 6 rCzA-- Atcy -r- L_ Title: / ei.[j_ • S4 ear Phone No:
Onsite Representative: Integrator:'^� +S -
Certified Operator: OM `J -4_�a^/ Operator Certification Number: 25 2 57 3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = { ="
Longitude: = ° = I = u
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population C►attle C**opacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder a9
❑ Non -Layer ❑ Da' Calf
❑ Da Heifer
® Feeder to Finish
ate®
❑ Farrow to Wean
Dry Poultry ❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Farrow to Finish
Gilts
Non -La ers ❑ Beef Feeder
❑ Pullets ❑ Beef Brood Co
EBoars.
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other I umber of Structures:
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
El Yes
,.,/
LI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
I NNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
LT 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)
El Yes
❑ No
,.,NA�
L-7 ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rro�❑
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El yes
,l��
Lei" o ❑ NA
❑ NE
other than from a discharge?
12128104
Continued

IFacility Number:82 3 j4 I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes :��001
NA ❑ NE
a. if yes, is waste level into the structural freeboard? El Yes NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
—�—s
Spillway?: Na
Designed Freeboard (in): 19
Observed Freeboard (in): _?0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,��
6. Are there structures on -site which are not properly addressed and/or managed El Yes L1No LJ 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? El 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 El L_TNo ❑ 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 LTNo LJ 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. Croptype(s) FesLcr�(Gr
13. Soil type(s) lVoA Gp A
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
omments (refer to question'#) 'Explai
QN��No
El NA El NE
❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
g _ *:
T ddrtional pages as necessary Use drawn s o
f facility to better explain setuatrons (nse a' A ..9M
�a rU t-ir 1-t<i'a..�,�c�-S iso fa 4-s.v
t. la Tr ., c,- rc-[J rc�7 S n..a�+J-rAln+� -io {r i�•��^1 It Z.
AA/al y ll'3 "'I Y!Zv ir- 2/`ZO0 i f_As-v c_& C r� / eS(!.
LQ caA/S Z a ►-L r iv k+CdVNeCh_jd ' �� �Q ✓v�� �L*G d V(S r
Reviewer/inspector Name,,?_s '� `4 ` `; Phone: If,33,334a
Reviewer/Inspector Signature: Date:
12128104 Continued

r
X
Facility Number: $2 —31 Date of Inspection
Required Records & Documents ,,_,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 13 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA El NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V
Rain Inspections ❑Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B'No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L] No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,��,__TNo❑
!_.10 No NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,L`
LTNo 0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Now❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
3< ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0'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
LSNo IJ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ffiNo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Bllo ❑ NA
❑ NE
d--4G }j� 1 ztrD9 .%
12128104

rA
/-o$-p4- 2
' vision of Water Quality
1Faci1ity 3, mber % ff
Division of Soil and Water Conservation
Q ether Agency
Type of Visit ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance '
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Dented Access
Date of Visit: Z dZ- Arrival Time: Departure Time: //�`2� County: Sv.✓ Region: �i�-e
Farm Name: -4e Ic v oar i4 r, Owner Email:
Owner Name: / O' -% eikrd"I Phone:
Mailing Address:
Physical Address:
Facility Contact: �'�a-� ' e Title: _ - Phone No:
Onsite Representative: Integrator: IYk4,0
Certified Operator: —FO 4,- Jo-a-S -,/ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o [= , = u Longitude: = o =1 0
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
:b Iatio
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ ,.
eerier to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La ers
EGilts ❑Non -La ers
Boars ❑ Pullets
❑ Turke s
Other ❑ Turkey Poults
❑Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ETNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
El Yes
0 No
�,/
L'1,, NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[I Yes
❑ No
E//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
❑ No
B<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number:FZ — 3/rj/
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure Structur� Structur� Structure 4
Identifier: �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 3<. ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [IIJZo Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L7 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes ❑ No El NA ❑ NE
maintenance or improvement?
Waste Application ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes B o ❑ 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) /CSGU C Siwy // ar�►•i✓ e'D, S , J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B l` o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 0-5o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
El Yes Blg0 [I NA ❑NE
❑Yes 0'lqo--❑NA El NE
Reviewer/inspector Name R 2V 1 S Phone: 9/0- S133.334rD
Reviewer/Inspector Signature: Date: /Z -0 2 — ZyO g
Page 2 of 3 I2128104 Continued

Facility Number: SZ — j/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E fo [I NA El NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check [I Yes L_TNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D<o ❑ 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
['10
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
I--]NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,,����Io
l_7No
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D 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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
��
B o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
[I Yes
�,/
L7 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
B o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
B<O ❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit -Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: © Departure Time:
Owner Email:
Phone:
Region:
�� Title: C �c�r� ✓ Phone No: %`� 9 2- as
Facility Contact: �p
ll'9i(rM9(0
aC�-StsYi Integrator: { e
Onsite Representative ]
r� tt
Certified Operator: D C� ULS j'-` Operator Certification Number: a5
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [ e [ [� Longitude: = ° = =
Design Current
Design Eurrent
Design Current
Swine Capacity Population
cK
Wet PoultryApacity Population
Castle Capacity Population
❑ Wean to Finish
❑ La er
❑
Dairy Cow
❑ Wean to Feeder
❑Nan -La er
❑
Dairy Calf
Weeder to Finish
- : . w�
N .=
El
Dairy He
❑
D Cow
❑ Farrow to Wean
" .:.
Dry Poultry `.
❑
Non -Dairy
❑ Farrow to Feeder -
❑ Farrow to Finish
❑ La ers
❑
Beef Stocker
❑ Gists
❑Non -La ers
❑Beef
Feeder
El Boars
❑ Pullets
❑
Beef Brood Co
❑ Turke s
::F;
Other1-1
❑ Other
TurkeyPoults
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes *o ❑ NA ❑ NE
❑ Yes
❑ No tXNA
❑ NE
❑ Yes
❑ No_JN3A
❑ NE
❑ No_;RjNA
❑ NE
❑ Yes
❑ Yes
*o ❑ NA
❑ NE
❑ Yes *o ❑ NA ❑ NE
12128104 Continued

Facility Number: -3 111 Date of Inspection l i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [ o ❑ NA ❑ NE
Structure t Structure 2 Scture 3 Structure 4 Structure 55 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): C'�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )(y
o ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 1§60 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes o ❑ NA [INE
(Not applicable to roofed pits, dry stacks and/or wet stacks) r
4. Does any part of the waste management system other than the waste structures require El Yes �lo ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )EZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes_lNo ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy 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) 1'�Gr 1' ►� l �QT-t ()�s , I--e-s 'e
13. Soil type(s) �O��p� k �"lbl� S 10OY () -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes "Wo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 'IA -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes "E
,X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes NTo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes )EtNo
❑ NA
❑ NE
'Comments (refer to question # ): Explam any YES answers and/or any recommendations or any other comments
:Use drawings of facility to better explainsituations..(use additional pages as necessary): a
�a
Reviewer/Inspector Name ST Kji� L A &) D ~~ �� Phone: � t C7 3 ico
Reviewer/Inspector Si -:nature: Date: Saj a
Page 2 of 3 12IM 104 Continued

Facility Number: a Date of Inspection Z k
`Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �j No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 1$lVo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes !!II o ❑ NA [I NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes �ZNo
❑ NA
❑ NE
❑ Yes P33+Io
❑ NA
❑ NE
❑ Yes KNo
❑ NA
❑ NE
❑ Yes Wo
❑ NA
❑ NE
❑ Yes Wo
❑ NA
❑ NE
❑ Yes '1�l3No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or.Drawings: U
�
�`�e - oh Q l rrtt l 3 ins I n"� .
0 �(
NC'C' �:a.r m I .
c e- I Lasq �- C-0vt V 0-r\ 1p-r
Page 3 of 3 12178104

41
Facility No(:�:L Time In(�A �>3 Time Out Date 13 d�
Farm Name _�C�r` �0�`' ' Integrator
Owner � I)XvG e..l * 6v Qo rAt twl.,30.Cbs)- Site Rep _ Jj1jja'
Operator WC.: No. 52= 17
Back-up
COC
C
M
Circle: General or NPDES
Design
Current
Desi n
Current
Wean —'Feed
Farrow — Feed
Farrow — Finish
ed
'�
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
ISiudge Su iey
Crop Yield
Observed
Calibration!GPM CAD ! 3�
Waste Transfers U /C ✓
Rain Gauge, Rain Breaker
Soil Test O Ob PLAT Wettable Acres
Weekly Freeboard V Daily Rainfall 1-in Inspections
Spray/Freeboard Drop r �� t to ! L j7P
Weather Codes
Waste Analysis:
120 min Inspections
Date _ Nitrogen (N)
2,D o � z .4
Date Nitrogen (N)
PulllField
Soil
Crop
Pan
Window

Qnews -� A -�Z_ 5�1 1 � C-9
h b�)
s
)7_
shy
cN S F "
�S�

Type of Visit omm Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit t^6outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date or visit: Arrival
_V Time: % a Departure Time: County:
Farm Name: TM Zyc1Kn r-af W Owner Email:
Owner Name: S u I V o. 7G Ckw) n Phone -
Mailing Address:
Region: rAb
Physical Address: (�
Facility Contact: Y 'Title: ` O C & �YiZ-P C Phone No:
Onsite Representative: Integrator,
ntegrator 10 rn C
Certified Operator:=0 M _ _ ,n � �CSbY1 — Operator Certification Number: a)
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 ="
Longitude: = ° = I = u
U
Resign Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
BTeeder to Finish C(A7S
= -_. `ry
El Dairy Heifer
El Dry Cow
❑ Farrow to Wean -s w
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
� Ill Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Lry No ❑ NA ❑ NE
❑ Yes
❑ No
Ld NNA
❑ NE
❑ Yes
❑ No
93 NA
❑ NE
❑ Yes
❑ No
M 1vA
❑ NE
❑ Yes [[>�] No El NA ElNE
❑ Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued

FAciIity Number: 5• -31
Date of Inspection a (e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I aZ
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes ❑ No A NA ❑ NE
Structure 5 Structure 6
Spillway?:
�l
Designed Freeboard (in): + bt t� Iq
Observed Freeboard (in): arcl
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes *"*IWo ❑ NA FINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 1VNo ❑ 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 VkNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes Ot' No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes r No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Application Outside of Area
12.
(Drift (❑
Crop type(s) l,llYllh 1'ul�" +-Iil r) t�R.�i 1�1; A19 Y Lf fty—IU JC
13.
Soil types) C 'Cp�L�
LS--Lf71 Cl�jlrp _
—
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
V No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
C4'IVo ❑ NA
❑ NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No El NA
El NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
,,�,,
Lld'lv//o ❑ NA
❑ NE
I &
Is there a lack of properly operating waste application equipment? ❑ Yes
UNo ❑ NA
❑ NE
lzi We CW 11 ro &A-+o [Q Mf7
n WxA; n� (=J64
r ryka uz hCl , Cj" 11
Reviewer/Inspector Name
Reviewer/Inspector Signature: ClaDate:
Page 2 of3 11/ /04 Continued

Facility Number: Date of Inspection � 9 c_o�� J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UVo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -Wo ❑ NA ❑ NE
the appropriate box- ❑ VVUp ❑ Checklists ❑ Desig
n [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I
PrNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1_^fNo
❑ NA
❑ NE
23-
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EPV
❑ 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
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
_No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
-PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"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
eNo
❑ 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
B No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
��!!
U o
❑ NA
❑ NE
33-
Does facility require a follow-up visit by same agency?
❑ Yes
ENo
❑ NA
❑ NE
Additional Comments`and/orMrawings: _-
C1 X elri +
U
Page 3 of 3
12128104

i
Facility No. — Time In 1 Time Out Date �f
A0
Farm Name Qm E�d vl i::�/ 1 n integrator _ f e1 rY� d _
Owner V 4- Site Rep ��� I ► d�
Operator 1 n m :SLl h No.
Back-up /
COC ✓
Circle: General or
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - Finish
p
Gilts 1 Boars
Farrow - Wean
Others
FREEBOARD: Desi
Sludge Survey
Crop Yield
Rain Gauge^
Soil Test PLAT
Observed
Calibrate nIGP ✓1 133
Waste Transfers ✓- 1�
Rain Breaker /
t/ Wettable Acres V
Weekly Freeboard Daily Rainfall
1-in Inspections
Spray/Freeboard Drop Q.,n- xj2�� v,. _ Aw__ _
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
R, " /. g
Vz
Date Nitrogen (N)
Iaa .� .
J ij A ) _�
Pull/Field
Soil
Crop
Pan
Window
Ram
r - S
bow
t
z�
9 3

Type of Visit ® Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Z ZS 0 , Arrival Time: = OD Departure Time: County: � Region: FRO
Farm Name: _ �� �cLTv►�.. Owner Email:
Owner Name: 1 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: &tt." ccc4_ _ Title: Phone No:
Onsite Representative: �� �OIGCM /� ntegrator: VS14='
Certified Operator: l .Two �a�{t:S� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = S ❑ Longitude: = o E:1 I = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish j
❑ Wean to Feeder
.Feeder to Finish 2-2" 60
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Currents: !:
Capacity Population-
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoAJ
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
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
J�j No
❑ NA
❑ NE
12128104 Continued

ii`acility Number: 82 — 3t
Date of Inspection Z LSO
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NNo ❑ 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 TJ'
Spillway?: Ato — _ f�]T�k1'2
Designed Freeboard (in): - 1. IT ? L� Z .2v• Y
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9 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
Q4No
❑ 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
C9No
❑ 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
B No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
rffNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes gNo ❑ 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 Drifl ❑ Application Outside of Area
Zia SD 131 264 rood 04
12. Crop type(s)_ 5 i ram, v s lk*,* Eyc
13. Soil type(s) 66e-c%o (o•sb i.•A4,r O •`t(o in
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 6No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes R9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 2�No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes J No - ❑ NA ❑ NE
* ' .
H • O[c) •&cw. -Cwr 6T*- � �r
rJ
Reviewer/Inspector Name" Phone: 9ra - `f $(n—/nI
Reviewer/inspector Signature: Date: 7_125-10 T�
12128104 Continued

facility Number: 8Z — 3 ! Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �94o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUK ❑ Checklists' ❑ DesigrIK❑ Mapir [:1 Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE
❑ Waste Applicatiokf ❑ Weekly Freeboard" ❑ Waste Analysis'❑ Soil Analysie""❑ Waste Transfer❑ Annual CertificatiW
❑ Rainfall ❑ StockinW"❑ Crop YieV ❑ 120 Minute InspectionVE] Monthly and 1" Rain InspectionY ❑ Weather Cod&----
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
5Lgo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
99 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ff No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
93 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
9No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
❑ Yes
0! No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
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-
�� � ��� O Division of:Soi1 and�Water Goaservatzon - � �ti �
Yr. x- y..a.r�,....��^.::".;..•,:-�";� :" x-..�?�.�':.,.. _:.-_ rF� x...-.-:.:5.,s.£-.w_ '�•', .,-^c.��.:�:a-.ax..;e.. _ ''�.rr-v:�-_ Type of Visit C—ornpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit t/ Routine O Complaint O Follow up O Emergency Notification Oder ❑ Denied Access
Facility Number Date of Visit: � Mine: .• S 6
O Not Operational O Below Threshold
M l?irmitted Ertextified. © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: CX art Ar,r+ _....... County:
Owner Name. �• �aCXSe�, Phone No: t: % 380
_........... _.... -- -. _ --........................................
MailingAddress: q g
:. ?....... .. !?�t'. ............�i4 �. "y :_.._.... t►�'� � . __ .. _ P
Q .'``� ........ ._.__... 7
Facility Contact: Title:.-__-. _
Onsite Representative: r`°SG h _ t �a J�
Certified Operator:.._.. 4d.- V41 _: :14-ks6&,
Location of Farm:
er Phone No:
Integrator: _.r
Operator Certification Number:.,,..,%? _
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • Longitude �• ���
Du, ' chai•ees - Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes 2090 0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes W'o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9<0
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
❑ Yes 21 To
Structure 6
Identifier: .......... ................... .. _. ..
,, 33
Freeboard (inches): t•}
12112103 Continued

Facility Number: q,� — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [RTo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 01'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes [�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes jINNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [] Yes [r10
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [<o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 03'<o
❑ Excessive PPonding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc 1
12. Crop type P lJ't ?X4Vt eL /§0"ajj";K / Kwr..�G/' AAKA4 ha l&1 Fe AM" I
13. Do the receiving crops differ with those designated-'designated-i the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [fio
b) Does the facility need a wettable acre determination? ❑ Yes ffio
c) This facility is pended for a wettable acre determination? ❑ Yes [Rqlo
15. Does the receiving crop need improvement? ❑ Yes B o
16. Is there a lack of adequate waste application equipment? ❑ Yes 13<0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [3Io
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [ io
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes L ,14
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 0<0
Air Quality representative immediately.
Reviewer for Name
Reviewer/Inspector Signature: f 0440 6�_1 f- Date: it/ir 10
12112/03 c.__ Continued

• Facility Number: ,� - 3/ Date of Inspection 5M
Required Records & DocumenU
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [RKO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes D'Ko
23. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes Grgo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes &M
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes M140
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Grko
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes M<o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�10
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
04es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Ko
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[r'No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
M1gO
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
E'No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After F Rain
120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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12112103

F�
State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr„ Governor � C
Jonathan B. Howes, Secretary C
Andrew McCall, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
September 14, 1995
Jackson Farm
ATTN: Mr. R.M. Jackson
2699 Fayetteville Highway (Hwy-13)
Dunn, NC 28334
SUBJECT: Compliance Inspection
Sampson County
Dear Mr. Jackson:
On July 26, 1995, an inspection of your animal operation was performed by the
Fayetteville Regional Office (FRO). Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office that this facility Is
in compliance with 15A NCAC 2H, Part A217, and that. Animal Waste Management is being
properly performed.
_Should you have any questions regarding this matter, feel free to contact me at (910)
486-1541.
Sincerely,
Ricky Revels
Environmental Technician IV
Enclosure
cc: Facility Compliance Group
Wachovia Building, Suite 714, Fayetteville. North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Site Requires Immediate Attention: ,�
Facility No. `S 2 - 31 V
DIVISION OF ENVIRONNIF.NTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: I M
Time: 16 : Z 5
Farm Name/Owner: 3 Fc - v i., RM h a c k-, o N
Mailing Address: z (P U -12) ,b u,vN NC Z R 3 3 4
County:
Integrator; Ong w cc a F6. V-►'._. s Phone:
On Site Representative:, To rv% if iDaN _To c_k_ seep Phone: 567- G jso � 5&-7 -_sz - �
Physical Addressilxcation: w _ Kr 2:'vC:c+.-Nc►-
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: -•-4 0 fl Number of Animals on Site:
�atD�_E``M Certification Number: ACE DEM Certification Number: ACNEW
l itude: s w Longitude:— e • ■
Circle Yes or No
Does the Animal Waste lagoon ha sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) 9Z No Actual Freeboard: Ft. o Inches
Was any seepage observed from the la n(s)? Yes ord&Was any erosion observed? Yes o�
Is adequate land available for spray? Ygr or No Is the cover crop adequate?�Y�r No
Crop(s) being utilized:_ )Zc ',J Craps , lj�e_rW"k.8 ,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 1por No
100 Feet from Wells? ligor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 0<�_97
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes OR
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oreg�D If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 4("_� No
Additional Comments:
Inspector Name Signatures
cc: Facility Assessment Unit Use Attachments if Needed.