820315_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Q'Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 91 routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; DO Departure Time: 3D County: ,S'�,�.�+-•• Region: ZEFID
Farm Name: r1w de e Owner Email:`�—
Owner Name: �, Faro -L n C, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone: j Ij
Onsite Representative: �$�c.`- Integrator:
Certified Operator: �'�� _ Certification Number: , 7" r
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q'1 o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
Design Current
❑ Yes
Design
Current
Design urrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle CapacityCPap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Layer
Dai Calf
Feeder to Finish
Heifer
Farrow to Wean
D
Design
Curren#
Dry Cow
Farrow to Feeder
D , Poult .
Ca aci
P,op..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
^-'
Turkeys
Other
-Turkey Poults
Other
I I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 Q'1 o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ No
❑ Yes
D_Tl o
[:]Yes
[r No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - / Date of [ns action: — 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structures 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ;1 �C Gera
Spiliwa}r?: Q
Designed Freeboard (in): /
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ 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 -No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes El"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [DDlo ❑ 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 [Ej< ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ffNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3&o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop /Window ❑ Evidence of Wind /Drift [] Application Outside of Approved Area
12. Crop TYpe(s)=Jrnr�d
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [jNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EI'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [i] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Q No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [3'No ❑ 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
E3-ko
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
2l. 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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E3 1"o
0 NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: v�z�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . No ❑ NA ❑ NE
h
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'<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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes h]o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ErNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[n"N—'o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ETNo
❑ NA
❑ NE
Comments (refer to question #) Ezplatn any YESanswers'andlor:,any additional recommendations or:any other comments.
Use drawings ©f factiityjto bette�7eaplain stystionsm(use additional pages as necessary,}
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: /i7 323--o137
Date:r���
2/4/2015

ype of visit: kv-,.ompitance inspection v operation Keview V structure rvamanon V i ecnnicai Assistance
Reason for Visit: 0-1outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L� Arrival Time: p a Departure Time: County:
Farm Name: 16b b eat rql-rrl— Owner Email:
Owner Name: T4a/rrL17 G. Phone:
Mailing Address:
Physical Address:
Region: FK
Facility Contact: Title: eV Phone:
Onsite Representative: S, Integrator:�„�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
sign Curren#
Design
Current
Design C•ttrrent
WDe
Swineapp city P,op.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.Wean
to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,oult ,
Ca acit
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Turke s
t ierM'111r' __ =
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 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 [N�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[]Yes No
Yes [.No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

FaE± Number: :515 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a, if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q-3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
a 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
[ANo
❑ 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
[a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 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
10 No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): adeta /cc/ fi .-n
13. Soil Type(s):___by'A-z Z A -M 'B LU
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [,R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
[:]Yes CEWo ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes J2[ No ❑ NA ❑ NE
i
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [vNo ❑ 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 [21 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [[ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
0 N ❑NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: 37-3)-5— jDate of Inspection: — —
1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eg No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®. No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CK 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes Co No
❑ Yes allo
❑ Yes MLNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: Y�;/Z) - -5y`DF-5 —/
Date:
u
21412015

t ype oI visit: {(,#C ompuance inspection %.J Vperation Keview U Jtructure Evaluation U i eennicai Assistance
Reason for Visit: G -Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: j [7 County: Region:
Farm Name: Owner Email:
Owner Name: g dy2 / / Phone:
Mailing Address:
Physical Address:
Facility Contact:� 1 f��'����g Title: / Phone:
Onsite Representative: S"G..-�� Integrator:���rjr�/1�%j��
Certified Operator: S Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Carrent
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
Design
Current
Design Current
[ j j No
Swine Capacity Pop.
®Vet PoWtry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
RN0n-L
Dai Cow
Wean to Feeder
er
I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean 0 v
Dry Cow
Farrow to Feeder
D . P,oul
Ca act
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
rl5eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes [2�No [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
f4 -No
❑ NA
❑ NE
[:]Yes
[ j j No
❑ NA
❑ NE
2/412014 Continued

Facility Number: - / Date of Inspection:
t Waste Collection & Treatment
S' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑-No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes nNo ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
M No
E]NA
E]NE
waste management or closure plan?
❑ Yes 5;�No
❑ NA
❑ NE
❑ Yes 0 No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
'R No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2 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 A plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &?-No ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground 0 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): '3 `fx
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes DE�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
R_enuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes �No
❑ NA
❑ NE
❑ Yes MNo
❑ NA
❑ NE
❑ Yes 5;�No
❑ NA
❑ NE
❑ Yes 0 No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2014 Continued

Facility Number: OL- Date of Inspection: &
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
F] NA ❑NE
❑NA F] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes INo E]NA E]NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes fg No ❑ NA ❑ NE
❑ Yes M No E] NA [D NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
E�No
❑ NA
❑ NE
Comments (refer to question #);E=plain-any YES answers and/or any additional recammendations orjany other co-zft .'
Use dravdngs offaeility to better eaplainsituations (use additional pages as.necessary) �, 3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Pho e: ; � r -u
Date: �_—+�33-3��
214/1014

Type of Visit: %Momphance Inspection V Operation Review U ,tructure Evaluation U 'Technical Assistance
Reason for Visit: GICoutine 0 Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: / ,' ys County: Region:
Farm Name: a,n_5 Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: }�� lC/� �li RFs Title: %11r s Phone:
Onsite Representative: Integrator: r� ,
Certified Operator: �Q _ Certification Number: /723/
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
i Design Current
❑ No
Design
Curren#
Design Current
;III Swine Capacity Fop.
Wet Poultry
Capacity
: Pog.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean o
Design
Current
Cow
Farrow to Feeder
D . F,ou1
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
„.
Turke s
Other
Turkey Poults
Other
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes R[ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
[Z.No
❑ NA
❑ NE
[—]Yes
E -No
[DNA
❑ NE
Page I of 3 2/4/2014 Continued

FaciliNumber: - / Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 % "¢ t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�,No
❑ NA
E] 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
X[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes„ and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ELNo ❑ 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): �- 1�v t//�r�- r e w-'-
13. Soil Type(s): _ GC2a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No 0 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
I& Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [RNo ❑ 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 [. No ❑ NA ❑ NE
❑ Yes [R No ❑ NA 0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ®.No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

Facility Number: - 3 J Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ENo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA F] NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes jQ No ❑ NA ❑ NE
❑ Yes [aNo ❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes &No
❑ Yes ELNo
❑ Yes EL No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �1_d _ y33 33L
Date:
2/4/2011

type of visit: Q9 t-ompuance inspection v uperauon xeview V structure r:vaivatnon V iecnmcai Assistance
Reason for Visit: tXRoufine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: [M;. N_ - Arrival Time: ' Departure Time: 737A County:
Farm Name: �0�(Q k'/IY1 Owner Email:
Owner Name: ,j5 �1hl` j7I �� 11_r_ Phone:
Mailing Address:
Physical Address:
Region: F�
Facility Contact: All -en W i [ I iows Title: Halo l Phone: ]
Onsite Representative: A) W;1 J"5 0, *py �jL Integrator: ColdsbO-D Hill 110 _
Certified Operator: DrWar A IV I�Cl1"5 _ Certification Number: }793)
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
-
Design
Current
00esTRWRurrent
Swine Capacity Pop.
W.et Poultry
Capaci#y
Pop.
Cattle Capacity Pop.
Wean to Finish
I
11-ayer
Da Caw
Wean to Feeder
I
INon-Layer
IDa
Calf
Feeder to Finish
Da Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , .P,oultr
C►a aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Clther
Turkey Poults
Other
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑No
❑ Yes ® No
❑ Yes & No
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

w
[Facility Number: T a, - 3) Date of Inspection:
Waste Collection & Treatment y
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier: p1 x W t Bj
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
Spillway?:
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
Designed Freeboard (in): 19
acres determination?
Observed Freeboard (in): a(e 4T
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[@ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Required Records & Documents
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 No
❑ NA
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
(3 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C' No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
['No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C )bRM Z 4 'Sm,7 164e,' 1pf
13. Soil Type(s): W / \ r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [Z NA ❑ NE
Page 2 of 3 21412011 Cona!inued

07,01
Facility Number: Date of Inspection: II 1a' 113
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes JZ No ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Er No DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes M No
❑ Yes ❑ No
❑ NA ❑ NE
®'NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes
[a No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
g No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
E3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
JZ� No
❑ NA
❑ NE
Comments (refer to question #r7: Explain any YES answers and/or any additional recommendations orsany,,otber coinifi'
Eise'drawings of facility to better explain situations (use additional'pages as necessary)
Lagoa, Ll sdjP_- -0 1i�t.1dAletnmtvpiv,� ,Xj),, 1 n � ej anouTw►
a years of r�a�hin� o,; o 0
CDA
Bann)-C—1-ej �4 r-eCords
Reviewer/Inspector Name: SCh h P)Pl- Phone: j
Reviewer/Inspector Signature: Date: IVQV�
Page 3 of 3 U 2/4/2011

.r
Facility No. Farm Name Wn 1 Date rad �3
Permit COC C3IC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
5 n M y,�R4
7�G����■r�IIR,
Lagoon Name, S forspill y 1 2 3 4 5 6 7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sluoe..Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
'A�i��� r�1�•�7�Q1�������r
fesign
■ • •nActual Flow
��.■��Fjjfl-----
Design Diam.
Soil Test Date �a I'd ��
Crop Yield
Transfer Sheets
pH Fields
Wettable Acres
RAIN GAUGE
Lime Needed
WUP
Dead box or incinerator
Lime Applied
Weekly f=reeboard
Mortality Records
Cu -1 Zn -I
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
I TIM 11, E..
..
sup.• . �. ,�[� ,
AS
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Re ords
Date last WUP at farm Lagoon # 517'q f•}4�K37C
App. Hardware Top Dike q9
Stop Pump 45'13
Start Pump 4-1,3
IA—r =9
Conversion- Cu -I 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac 1,7
S jr.31¢( 6 qYK asr
qb?
qoq %5,0
I.?

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes qj No ❑ NA ❑ NE
24. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes b@ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1P 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
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Jj5 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z) No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
f3 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
AdciiitionalCommentsiindlor Drewings,*
a
12/28/04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Ar�jriiivvalTime. �� 1►, Departure Time: �� �� OdM County: Jy"' Region: �Z
Farm Name:9a`Owner Email:
n r
Owner Name: DObCQE RWM S Ur- Phone:
Mailing Address:
Physical Address:
Facility Contact: Otn c, eAgweTitle: Phone No:
/�
Onsite Representative: Integrator: i aXI ( PAA's
Certified Operator: Db W a t I+t'►-5 Operator Certification Number: 117231
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =I =61 Longitude: = o = t ❑ u
jj
Design . Current DesiginCurrent .
Design Current
Swine
Capacity Population Vo I y� CapUN K Pop lair
Cattle Capacity Population
❑ Wean to Finish
❑ Layer ❑ Dai Cow
❑Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ No
❑ Dai Heifer
Farrow to Wean
=D Poult" = "
❑ D Cow
El Farrow to Feeder
log U'. s s
� ers
❑ L
El Non -Dairy
❑ Farrow to Finish
-a
� El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Boars
❑ No
❑ Beef Brood Co
❑ NE
! ElTurkeys
❑ Yes
Other y
❑ Turkey Poults
❑ NE
❑ Other
❑ Other
";Number of Structures:
❑ NA
❑ NE
other than from a discharge?
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
qjNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
O NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ep No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1PNo
❑ NA
❑ NE
other than from a discharge?
Page Y of 3
12/28/04
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ 6NA ❑ NE
Structure Structu;e2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /V bt
❑ Yes
Spillway?:
❑ NA
Designed Freeboard (in):
15. Does the receiving crop and/or land application site need improvement?
Observed Freeboard (in): L1307 3
VINo
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA EINE
(ie/ large trees, severe erosion, seepage, etc.)
PNo
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
[)-!PNo ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes
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
10 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[)TNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
❑ NA
9. Does any part of the'waste management system other than the waste structures require ❑ Yes
PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
P No [:1 NA ❑ NE
maintenance/improvement?
]L _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
JPNo ❑ 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 offAcceptable Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
pCrop
12. Crop type(s) P -f PYIC_'T5S Sfn, �n Wf sad, Caen
n Suninc114
13. Soil type(s) VAv.44-y V;
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[aNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VINo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
PNo
❑ NA
❑ NE
IT 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
44No
❑ NA
❑ NE
Comments. {refer to q�esteon #) �Eaplain any YES=answe_rs and/orasn recommendatiiinsrorAany other�commen ts. ;
41Usedrawyngs of�factlity tolbetter explain situations:(useaddtttonatipage�sasnecessary) y
r
Reviewer/Inspector Name
10Phone: �0 r33CD
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12/28/04 Continued

Facility Number: -3 Date of Inspection O O 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VU No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑ Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CgNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1!�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J],No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4 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
ZI No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on-site representative?
❑ Yes
f9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VLNo
❑ NA
❑ NE
Additional Eoimments and/or Dtawtngs
f
Page 3 of 3 12/28/04

0 Division of Water Quality
Facility Number .=�—E��� 0 Division of Soil and Water CQDServatlon
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I ra t Arrival Time: : t yr. Departure Time: I County: sJq'17 Sa n%
Farm Name: �CQ� Fa Owner Email:
Owner Name: Ob h�M $ tGCC Phone:
Mailing Address:
Physical Address:
Region: ELD
Facility Contact: rU M00re __ Title: Phone No:
`
Onsite Representative: W t Integrator: [ OCt.1TO�l 1 �L&�n Figi �1�
Certified Operator: 4 Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0 =1 ="
Longitude: = ° 0 f = "
Design Current Design Current Design Carrent
Swine Capacity Population Wet Poultry -Capacity Population Cattle Capacity- Population,'.;
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean 600
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑
Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [;3 No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
02 NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12/28/04 Continued
1

Facility Number: Date of Inspection 1 07
❑ Yes
Waste Collection & Treatment '
❑ NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No [N NA ❑ NE
Structure 1 Structur Structure 3 Structure 4
Structure 5 Structure 6
/2
Identifier: 0 0 !7
E3 No
Spillway?:
❑ NE
Designed Freeboard (in):
❑ Yes
u
Observed Freeboard (in):
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes )S No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
RNo
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes g'] No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 53 No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JM 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 ❑ YesNo ❑ NA ElNE
mai ntenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofpAcceptable
/Crojp� indoow❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) rlC�/�"'.Qtet ' [ ��`1 d"" �" 1� lj'tt1✓� n O �^�','i� " ��� (� N
13. Soil type(s) b)Aa,2 ,,,, — � .C�t!,y,7
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JM No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerllnspector Name Phone: /0 a
Reviewer/Inspector Signature: Date: 7�
' 11/28/04 Continued

Facility Number: — Date of Inspection
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NNo ❑ 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
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ 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
19 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
JU 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
Q9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(L+No
❑ NA
❑ NE
Additional Comments and/or
12/28/04

r
Y <. Division. of Water Quality
Facility Nutrier O Division of Soil and Water Conservation r' 4
Q Other Agency.
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:_ Arrival Time: Z yr t+. Departure Time: County: �.ti Srv. Region: 14!e
Farm Name: �i?E2C,r �a vhf Owner Email:
Owner Name: - ��,_—O�j'� Phone: _z S%3i�0
G�✓:'
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: __,../. —e–'4,!! '(4'%o r C
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=o =' � =o ❑, � «
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
1; 10 Non -Layer
Dry Poultry
❑ Layers
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (1 f 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 CR No ❑ NA ❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
Cr o
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[Y No
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
11/18/04 Continued

Facility Number: 1 SS Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ALidl d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3(y ff
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C No ❑ 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 LMNo ❑ 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 P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [KNo ❑ 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 1�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes yyNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IgNo ❑ 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 Dri fi [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
1A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1'No
❑ NA
❑ NE
Reviewer/Inspector Name /, ��� ,. , Yn'' Phone: 7'0
Reviewer/Inspector Signature:Date: .51 —/ S— ZOO&
12128104 Continued

Facility Number: rZ -3/5 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3 No ❑ NA EINE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design g ❑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 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Lei No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
DdNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[;FNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [ No ❑ 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 VNo ❑ 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 10 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 ONo ❑ NA ❑ NE
12/28/04

Date afVisit: "�y'a Time: _%/�/�
10 Not Operational 0 Below Threshold
[115ermitted 0 Certified 0 Conditionally Certified [] Reggistered Date Last Operated or Above Threshold
Farm Name: '64_CGt,/�_ _ Fd2ro County: p5olti r1?0
Owner Name: He/1oore Tr Phone No: —WO- 99.2 - 3`7 9
Mailing Address: P„0. d vX 766 e, k,7Vo,, NC 2 93 2 1?
Facility Contact: )ye.'C;444pure, Title:
Onsite Representative: HL°nr �1Ddr>'
Certified Operator: 4/4.-2 �✓ �!_i�+,z�_-_ _ ___ _ __
Location of Farm:
Phone No: 9707` 5'3_-2 ^ 433
Integrator: 6Q/'roll S food, .The .
Operator Certification Number: %g 3Z
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �' �” Longitude ' �•
Design Current
Swine rnnnrity Pnnnl9finn
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean i4goo S :2 OLI
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
FP—Lav er ❑ Da'ry
❑ Non -Laver ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons �.J ❑ Subsurface Drains Present 110 Lagoon :area 10 5 rav Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges d Stream Impacts
1. is anv discharge observed from any part of the operation? ❑ Yes F�Ko
Discharge originated at: ❑ Lasoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? El,2 Yes NO
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes 13 No
c. If discharee is observed, what is the estimated flow in gal/min? `r
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes E911c,
2. is there evidence of past discharge from any pan of the operation?❑ yes , -o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
El Yes lo
Waste Collection & Treatment ,_ ,
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes U1Vo
Structure 1 Structure 2 Structure 3 Structure 4 Structure ; Structure 6
Identifier: / Z
Freeboard (inches): w _� 7 .3 5-
05103101
05103/01 Continued
Facilitc lumber 3

Facility Number:— 31 S Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes [ 1 o
❑ Yes Eg No
❑ Yes['"No
❑ Yes j2�No
❑ Yes E(No
Waste Aaulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes !moo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2*o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type UP,."/. , .Sine.// -
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes B -Nn
14. a) Does the facility lack adequate acreage for land application? ❑ Yes B -No---
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes 9 -Ko -
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ©'N -o-
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 214_0
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [31qo
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 0-1qo_
Air Quality representative immediately.
Conts;(cefer tq gnesban) ' Eyrplarn any YES answers andlor artyrouonniendatioas ar any oti;er commeats..' Y s
. _�_. 1 - 'ter=
=Lisa drawings of far�xty to better expla<n szt�a�ox�s. (use addxhoraal pages as aery) veld Copy ❑ Ftnal Notes ( �
/� f
bo
-SoM e Ero��'n n0 �� df0un� �Aq aen bon J �PwSC' COn'I'n v�
�d QV V.,
PlPale /'+o'#Yar 41,�
Hw
Reviewer/Inspector Name /yjar�,. �r � Luer [rxl f ,
pWii ,
.,..,'' rcllm�c�
_ rpt
ReviewerAkspector Signature: Date:
-/Z( - U
12/12/03 - Continued

• Facility Number: — 3 j q_ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/,WU>rchw1ffs_ts, dmW,.P ips, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ W_43v—_ aFian ❑ said ❑ ate An", ' ❑ZO+S nt+rT__
3-9 Go , aG a N J. 1
24. Is facility not in co Hance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewer/Inspector fail to discuss reviewfinspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NTPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
,U�Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDE5 required forms Reed improvement? If yes, check the appropriate box below.
❑ Steeki►g-Form ❑ C&ep-Y4ed-Form ❑ Raid ❑
❑ 120 Minute Inspections ❑
❑ Yes ❑.NT
❑ Yes E iu
❑ Yes [moo
❑ Yes Eg-Ne
(0WO U 9!.iM'
❑ Yes E No
❑ Yes allo
❑ Yes &14o
❑ Yes �To
QWs— ❑ No
❑ Yes O' No
❑ Yes 01'+3'6
❑ Yes Plb
❑ Yes
❑ Yes [ FNo
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditi6nal C6ttiments andlOr.,Diawin
Etc;''�/ �lus con�trc�PN a S��cJ�ef ��S �1vf /'tce;vel
a �pPy frv�n 14e cd�.P� y t� PtrTor*.s�
3 `s c✓3Seal %Iow �o nv/P %SCJ in v�i ,'.r Stec V/ &Ts 0., Zfl? - !
l2/l2/03

Site Requires Immediate Attention:
Facility No. Sa - 3 1,5
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _'5-1 -2-5 1995
Time: t S
Farm Name/Owner: li?D c , ',,+ Fac- M5
Mailing Address: o _F?=- 0-1- '� f9 Cs Ct . �� _ l�1 C_
County: 5 V-,% c-_ �­ s o *t -J
Integrator: C -A izVl,,v t- Vcx�,os Phone: C%,o - 'tea - O 1 Lt 1
On Site Representative: Phone: EL o - Li2-P-3 Q
Physical Address/Location: 'CIC F SR l 1?Q l l e s �� .� -, d � t f� �►,E��.� cR
Type of Operation: Swine
Design Capacity: -X 1-+ Q c'
CA -
ra-A
Poultry Cattle
Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: 0' "
Circle Yes or No
Does the Animal Waste Lagoon h sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard: � Ft. G Inches
'Was any seepage observed from the oon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Y or No Is the cover crop adequate?Y� or No
Crop(s) being utilized: o
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelli Yes r No
100 Feet from Wells? or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue me: Yes oic
Is animal waste discharged into water of lkstate by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management recolds (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? e r No
Additional Comments: N,,_kJL rz a� c�
V QeA 4 _G
M\C.1ng,¢ L W« -Kt -<-
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

hype of visit: p Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: & Routine O Complaint Q Follow-up O Referral Q Emergency 0 Other Q Denied Access
Date of Visit: j Arrival Time:��Departure Time:County: �N
FTFarm Name: VVI Owner Email:
Owner Name: Ms LL -r— Phone:
Mailing Address:
Physical Address:
Facility Contact: AI kr. Title:
1�
Onsite Representative:
Certified Operator: U
Bach -up Operator:
Location of Farm:
Latitude:
Region: F424D
Phone:dl
Integrator: 1A 4
Certification Number: 1 7 t3!
Certification Number:
Longitude:
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 V2] No ❑ NA ❑ NE
[:]Yes
Design Currents
[ig NA
Design
Current
Design Current
Swine
Capacity I'op ` �-
WaOil! oultry
Capacity
Pop.
Cattle Capacity Pap.
....
-
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
D , Poul
Layers
Design
Ca aci
"` `
Current
Pio
Dai Heifer
D Cow
Non -Da'
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
' :.
Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes V2] No ❑ NA ❑ NE
[:]Yes
❑ No
[ig NA
❑ NE
❑ Yes
❑ No
5 NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:)No
❑ Yes T No
[] Yes [4 No
M NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 2/412011 Continued

laacili Number: Date of inspection: I
/L
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: 1 —/v�1�L'brfD
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
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
W No
❑ NA
❑ NE
S. 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
[V9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
IM 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): 1-a
13, Soil Type(s): A-
14. Do the receiving crops differ from those
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?
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes [P No ❑ NA ❑ NE
[] Yes ` @ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [M No ❑ NA D NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ N E
❑ NA ❑ NE
Page 2 of 3 214/1011 Continued

Vacility Number: ('-5— Date of inspection: 10 1 11 L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []n No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EP No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [n No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34_ Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #j: Explain any YES answers and/of any additionalrecommendations or;any Other comments
Ilse drawings of faciility to better explain situations (use additional pales as necessary).:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A4,b
Phone: 3300
Date: I e/ 7 1 Z
2/4/2011

Type of Visit: # Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ID Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:Departure Time: �,� County:
Farm Name: ,yl/L Owner Email:
Owner Name: �B� t�tA ` �yI,CC LLC Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: A6 N/4 1�(�Q�ls Title: Phone:
Onsite Representative: t� lntegrator:
zj'W2Wf 1-t
Certified Operator: a Certification Number: 17
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
, Wean to Finish La er
, +'
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
NA
Layer
. -
.D, p �Poultr
La ers
Design
Ca aei
-
Current
Pio .
Dai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
NA
C]NE
c. What is the estimated volume that reached waters of the State (gallons)?
Gilts
Non -La ers
d_ Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
Beef Feeder
❑ NE
Boars
❑ Yes
1pullets
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Beef Brood Cow
No
Turkeys
Other. Turkey i'oults
❑ NE
Other
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ NofT
NA
C]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
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facilit y Number: IDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I
Identifier:
Spillway?:
Struuc�tuure� �2 Structure 3 Structure 4 Structure 5
�jw
19No ❑ NA ❑ NE
❑ No � NA 0 N
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 171 Jam'` 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 N No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes g] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EA 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes fig No ❑ NA ❑ NE
❑Yes [PNo E] NA E] NE
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes [�] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wiindo�❑Evide ce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): G 4*e)sm ILl
lsl ffi�.N d JOW0c�c
14. Do the receiving crops differ from those designated in the KAWMP?
❑ Yes
� No
E] NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Qg No
[] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19- Did the facility fail to have the Certificate of Coverage & Pen -nit readily available?
❑ Yes
No
❑ NA
❑ NE
20- Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
r
❑WUP [I Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes _P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? E]Yes ZNo
0 N E] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
E:] NA ❑NE
Page 2 of 3 2/4/2011 Continued

Other Issues
Facili Number: Date of Ins ection:
O
❑ Yes
No
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�] No
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? 1f yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below_
No
❑ NA
❑ NE
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
List structure(s) and date of first survey indicating non-compliance:
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
V] No
[] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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.
[j Yes
[y] No
❑ NA
❑ NE
❑ Application Field E]Lagoon/Storage Pond ❑ Other:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[)E No
❑ NA
❑ NE
33. Did the Reviewer/lnspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�)No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES'answers and/orany additional recommendations or.any ©tticr cowments,
Use drawines of facility to better explain situations fuse additional uaees as necessary).
Reviewerlinspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q'v—q�%-5fev
Date: W. -VI
2/4/2011

Type of Visit ! Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I I Arrival Time: Fri QOi;j Departure Time: , County: �r Region: 4`0
Farm Name: _006 R/w- „ � Owner Email:
Owner Name: (2006_� I"tM S LLC Phone:
Mailing Address:
Physical Address: ++ , f
Facility Contact: � W 11,44"5 Gv
fTitle:
G
Onsite Representative:
R
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity P,opu�lati�on
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =I ="
Longitude: ='D = ' = L
I j11' Design Current
Wet Poultry Capacity Population
❑ La er
❑Non -La er
Dry.,Poultry
❑
Layers
❑
Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daiiy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures10
1. 1s any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ 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 1 of 3
12/28104
Continued

Facility Number: P-3
Date of Inspection
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: DO dw
Spillway?:
Designed Freeboard (in):
ji
Observed Freeboard (in): _�� 3
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?
El Yes 0 N El NA LINE
❑ Yes ❑ No ❑ 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? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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)c--Vk"G,,�,Lkc,,J��U
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA W MP? ❑ Yes 8 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 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 Jj§No ❑ NA ❑ NE
Comments (refer to question #.): Explat any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary}:
Reviewer/Inspector Name �• rt� Phone: IU a
Reviewer/Inspector Signature: Date: 1 a$ %°
Page 2 of 3 12/28/04 Continued

Facility Number: Date of Inspection 7 c7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (V 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
ILJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
tNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ 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
�p No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Additional'Comments and/or DrawVngsc x<�`
AL
Page 3 of 3 12/28/04

Type of Visit I, Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / 1�t�I Arrival Time: Departure Time: D9-'3� County: Region: FWQO
Farm Name:
``TTTT per" Owner Email:
Owner Name:�liit S — Phone:
Mailing Address:
Physical Address:
Facility Contact:{ '�+� + + QT'S Title:
N
Onsite Representative:
V
Certified Operator:
Back-up Operator:
Location of Farm:
,�,
�Phone No-
(�
Integrator: aq>Q
Operator Certification Number: �3
Back-up Certification Number:
Latitude: =0
=1 =" Longitude: = ° = =
J
Design Current
Design Current
Design Current
Swine Capacity Papulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
a. Was the conveyance man-made?
❑ Yes
to Feeder
❑ Non -Layer
airy Calf
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
FOWean
Feeder to Finish
ENA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Dai Heifer
Farrow to Wean
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
Dry
Poultry
❑ Dry Cow
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Farrow to Feeder
No
❑ NA
❑ Non -Dairy
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
other than from a discharge?
Gilts
❑ Non -Layers
11 Beef Feeder
12/28104
PE:1Boars
❑ Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Turkey Poults
Numructures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[�fNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
y
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
ENA
❑ 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
[P NA
❑ 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?
12/28104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
structure 1 Structure 2 Structure 3 Structure 4
Identifier:A��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ? �26"
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which arc not properly addressed and/or managed
through a waste management or closure plan?
❑ YesNo ElNA [INE
❑ Yes No ,I NA CINE
Structure 5 Structure 6
❑ Yes QgNo ❑ NA ❑ NE
❑ Yes VPNo ❑ 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? ❑ Yes 09No ❑ 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 parrof the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
1 1
14. Do the receiving crops differ from thoseesignated in the CAWMP?
❑ Yes
EM No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
59 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
19 No
❑ NA
❑ NE
17. Docs the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J9 No
❑ NA
❑ NE
'Commen#s (refer to question #):. ExplainanyYES: answers and/or any recommendations or ani other�comments °
Use drawings of faeility to -better explain situations. (nse additional pages as necessary) `'-
z
Reviewer/Inspector Name ;; Phone:
Reviewer/inspector Signature: Date:
a
12/28/04 Continued