820345_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Is, 'M s a 7 J u K
— - —_ ivision of Water Resources
Facility Number - t{ Division of Soil and Water Conservation
� Other Agency
Type of Visit: CKOm liance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: er Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Z6,x,At, Arrival Time: ' 0 Departure Time: County:' Sd Region: FlW
Farm Name: o 9� too- o- FG e vLA- 5 Owner Email:
Owner Name: L a Y 4 Phone:
If
Mailing Address:
Physical Address:
Facility Contact: Cu4''�t5 ] �e�icf (.[,e!�L Title: Phone:
Onsite Representative: Integrator: M 6--'s
Certified Operator: e rry J N�Cy to ✓` Certification Number: y S
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
- Design Current Design Cnrren#
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish O
Farrow to Wean
Design Current
Dr. Poultry Ca aci $o
Layers
DairyHeifer
D Cow
Farrow to Feeder
Non-Da'iry
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
--
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[+Nl� — ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[D-NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
[D-NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
0 No
_�
[�'NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ f�ia+
[DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
O'lg0
[DNA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

gpq
F'acili umber: r5A - 3qc jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ��� NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3—NA— ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[�Pd'o' ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
CZJ) o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:],Nor— ❑ 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
[9"lgo ❑ NA
0 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 [2,55- DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 13 f`' C1 fo - (r d
13. Soil Type(s): A/ o ! tj a-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [L]'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 0`Now❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑`lro ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes CaW ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑,O [DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑'1 0 ❑ 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 F71, ' ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspecti;�_N�
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi -Number: 9 Z - 3" Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[g"< ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
D-Nlo ❑ NA
❑ NE
the appropriate box(es) below.
0 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
0'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
Fj N`o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I +]- o
❑ 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
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
Q'<o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]J"J1O
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ rl o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to questions#)E�latnlany YES answers andlor any addrtional.recd- endations or any'�ottter comments.
USe draw,.ln 5 Of( r:.sJ`y'�„ x m is yc 7
g k factlity to�6etter explasn situahons'(use additional pages as necessary,) '.. ,k
21 7
o. 3,3 - f - ,j.
Ct,a 110- 3_0 9- R Sr
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone: f o fl - 333.q
Date: `` "./I
(9
21412015

a
i�islon of Water Resources
Facility _Number - c $� ® Division of Soil and Water Conservation
® Uther Agency
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: "outine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: 70Departure Time: 2 On County: Region: Ffzc
Farm Name: Owner Email:
Owner Name: QdVAy ``` Phone:
Mailing Address:
Physical Address:
Facility Contact: l S 1'J 4ef, A"/7 Title:
Onsite Representative: ti(
Certified Operator: tle/ y �104
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: kl, 6 _S
Certification Number: fI I, (s
Certification Number:
Longitude:
Design EurrenY Design =Current
Design Current
Swine' Capacity Pop. ,' Wet Poultry Capacity. Pbp,
Cattle Capacity Pop.
Wean to Finish
-
Layer
Dairy Cow
Wean to Feeder
5T1
INon-Layer
Daia Calf
Feeder to Finish .._
- b
_"" a = `
DairyHeifer
s
1
�-- ...u:
I;
- Dry�Pault . Cae n ac en't
Farrow to Wean
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Gilts
Boars
=
"
Pullets
I
113eefBroodCow
Turkeys
©ther
M
Turkey Poults
Other
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes. notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes l414- ❑ NA ❑ NE
❑ Yes
❑ No
E2-f-4A
❑ NE
❑ Yes
[] No
[] NA
❑ NE
❑Yes ❑No
❑ Yes ❑"No
❑ Yes [ No
[3"NA
❑ NE
DNA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection: •S dim
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q'No_
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
.r
Observed Freeboard {in}: 2_3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[g'NO
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [D 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 05C ❑ NA ❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Oo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ea/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): No to-L,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EE'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [� o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EEJI fo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E2-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
Epl�o
❑ 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 o ❑ 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 [ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EftTlo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaCility Number: 2 - 3 tj = I Date of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q o
❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3No
❑ 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
[�-1~To
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[3-go—
❑ 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?
f 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 reviewh nspecti on with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes [ ❑ NA ❑ NE
❑ Yes ❑.Na ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ©o ❑ NA ❑ NE
Yes
[io
❑ NA ❑ NE
Yes
Yes
❑
❑
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C41 - T 0- 3v91.- 6S Si
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
PhorCe 3 JYJ 3 3 r
Dater S n_
21412015
Page 3 of 3

aJ►kkp ;I Z-),A-t t6 eb
(Type of Visit: (Compliance inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: erioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
­ .1
Date of Visit: 12 bAffAvIbI Arrival Time: Departure Time: TT County: Region: 1�
Farm Name: ��.� �� ELL Owner Email:
Owner Name: yt Phone:
Mailing Address:
Physical Address:
Facility Contact:
aW�l t/ " Title:
Onsite Representative: J�
Certified Operator: Ui/C� �ELGJIIj'+
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: Y S
a
Certification Number:
Latitude: Longitude:
lJesign Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Feeder to Finish
I INon-Layer
I
Calf '
airy Heifer
Farrow to Wean
Design
Current
jDryCow
Farrow to Feeder
D . P,oult .
Ca aci
P,a P.
Non -Dairy
Farrow to Finish
Gilts
Boars
Layers
Non -Layers
Pullets
Turke s
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑ NA ❑ NE
[::]Yes ❑ No
❑ Yes [:]No
MINA ❑ NE
ff 'NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ No [* TA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [?*'go ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Fackity Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. if yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
214W-- ❑ NA ❑ NE
❑No gj� ❑NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): `� 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
�
❑ NA
❑ NE
❑ Yes
L io
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 211 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0'Ko' ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2"1Go ❑ 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): Kok <2 G L)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [v]"Po ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2<o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑'&o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Olo ❑ NA ❑ NE
❑ Yes �lo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VJ-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ 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 4>0
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 21412014 Continued

Facil' Number: - Date of inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes aC ❑ NA ❑ NE
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 to provide documentation of an actively certified operator in charge? ❑ Yes Q�Xo [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C2,-iQo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [R No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E2�No ❑ NA ❑ NE
❑ Yes [20"No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑'No ❑ NA ❑ NE
33. Did the Reviewer/laspector fail to discuss review/inspection with an on -site representative? ❑ Yes [TNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes [2 No ❑ NA ONE
Reviewer/Inspector Signature:
Page 3 of 3
21412011

i ype or v isir: L...%,uompuanee inspeenon v uperanon meview V arrucrure mvaivanon l) i ecumcai Assisrance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r6� Departure Time: ( County: Y'�" j/�- Region:1 ` V, 6
Farm Name: �-"� it �`- ���� Owner Email: ��
Owner Name: L_ Phone:
Mailing Address:
Physical Address:
Facility Contact: r.,,jc5 Title: Phone:
Onsite Representative: r Integrator: '] 1
Certified Operator:ccJr`J 'lfacy�o�`
Certification Number: ! tc 15
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
P Design Current
Weta6Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Tff O
Design
D . Fault . Ca aci
Current
Po P.
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
IRS
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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 Q NA ❑ NE
❑ Yes
❑ No
[:]Yes
O No
[:]Yes
❑-No
D` A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

.r ry I,,. —
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-lqo__�❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
e 1-gA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
<o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
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 �lo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes B o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes In -No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D40,
❑ 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.'"�
13. Soil Type(s): No✓'- Qa
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
�Ia
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E['�ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E]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
E3-No
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[-]Yes do
❑ 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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[::]Yes �No
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[::]Yes eNo
[DNA
❑ NE
Page 2 of 3 21412011 Continued

.
Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[&bLw- ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[Djbla-'� ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels 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
C14o DNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
E; ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
la ❑ 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.
❑ 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
io ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F�<o❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
/
[�]'NO ❑ NA
❑ NE
Reviewer/Inspector Signature:
r� 15
2/4/2014
Page 3 of 3

Type of Visit: O'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &I routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regiou/Tb
Farm Name: ylrJfj �1&t Z ll j Owner Email:
Owner Name: t Phone:
Mailing Address:
Physical Address:
Facility Contact: C* r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone g
Integrator: fl �J �y
Certification Number: If l
Certification Number:
Longitude:
Design Current
DesignCurrent
ine Capacity Pop
FDign�Current
Wet Poultryacity Pop.
Cattle Capacity Pop.
-
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
De' Current
airyHeifer
Farrow to Wean
D Cow
Farrow to Feeder
D , P,ouit
ci l'oP.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
. ,.....
Turkeys
n r
Other
Turke Puults
Other
Other
Discharzes 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)
❑ Yes ❑a,�K'❑ NA ❑ NE
❑ Yes [-]No
❑ Yes [] No
i, "A ❑ NE
D-KA ❑ 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 Ej NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [..jNho ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes Io ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

t
Facility Number: Date of Ins ectio
IV I
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C'
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
9� ❑ NE
Structure 6
❑ Yes UNd ❑ NA ❑ NE
❑ Yes C rNo ❑ 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 o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2-1"° ❑ 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 compiiance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
I 1 _ 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): &^Vw� SG-D
13. Soil Type(s): cov­
14. Do the receiving crops differ from those des ated in the CAWMP?
❑ Yes
g�FNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EJNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z].AIo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[]Yes
Oglqo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�fo
❑ NA
0 NE
the appropriate box.
❑WISP ❑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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
8No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
&rNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 4� Date of Ins ection: fi
y
24_ Did the facility fail to calibrate waste application equipment as required by the permit? fig ❑ Yes �o ❑ NA ❑ NE
❑ G❑
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 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 EJ No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [allo NA [] NE
Yes No NA NE
❑ Yes Ej /No [] NA NE
Yes E34o NA ❑ NE
[:]Yes
[� No
NA NE
c fo
[] NA NE
L L — o
❑ NA NE
[� Yes
❑ Yes
Comments (refer to.question #): Explain any YES answers and/or any additional recommendations or any oth co�m`tne, .nts , .
Use _drawings of facility-to.better explain situations (use additional pages as necessary). 4^ ;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
--3"c- F 3 4 5 L (- '(�
Phon�r
Date: I!ArJ�
2/4/20II

Ii ype of visit: ty compnance inspection V operation meview v structure t~vatuation V i ecnmcat Assistance I
Reason for Visit: 01�outine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: J Q Arrival Time: n Departure Time: County: �!{ MQ�f,�i Region: I -Ad
Farm Name: q pR �{Z r�R e, L� Owner Email:
Owner Name: �qR(�v �q�� p {Z Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: "<V\9-
Certified Operator: 4�tZt�.(_ NAy jo f-
I-
Back-up Operator:
t� Title:
Phone:
Integrator: MuR12&j
Certification Number: �i S
Certification Number:
Location of Farm: Latitude: Longitude:
Design C•urren_t
Design
Current
Design Current
Swine
C►opacity Pop.
�� et P_oultt.,
C►opacity
Pop.
Cattle C*opacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
L7
''``
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr _P�oultry
Ca aei .''
1?0
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes g2"No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes []No Ef NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No [INA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No N�rNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes v(No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: TS a -34S jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [1. o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [Z�XA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in): cj
Observed Freeboard (in): O
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes GJNo ❑ 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 12'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 [�Io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes 2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [21F o
[DNA
❑ NE
maintenance or improvement?
Waste Application r
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes & No
[DNA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �No
❑ NA
❑ NE
❑ Excessive Pending ❑ 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 Acce table Crop Window [:)Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s)�
13. Soil Type(s): I1j G i 1 IJA _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [131""No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [�No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [VrNo [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
['Vo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[fNo
❑ 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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[1/No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No Ej--NA ❑ NE
Page 2 of 3 21412011 Continued

w �
Facili Number: r5ate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M"Po
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 provide documentation of an actively certified operator in charge? ❑ Yes KrNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAN') certification? [:]Yes YNo
❑ NA ❑ NE
[ a,NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[gNo
❑ 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
G24No
❑ 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
[t, Rio
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E340
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[(No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[/No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Fg/No
❑ NA
❑ NE
Comments (refer to question #t): Explain any YES answers and/or any additional recommendations or any other comrnetits.
r
Use drawings of facility to better explain situations (use additional pages as necessary) . :-, .5,t
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
t-1 V-5 _ _ Phone: q \0` _±� -LA5)
_ Date: Q }�
21412011

WIV II/ q-Al-
Type of Visit: QfCompliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
r
Date of Visit: Arrival Time: 1,2,,ICO Departure Time: County:i Region:
Farm Name: Owner Email:
1
Owner Name:-{,�rt�y {�{—' Phone:
Mailing Address:
Physical Address:
Facility Contact: (j"S 1L,� Title: , Phone:
Onsite Representative: 60.r.n Integrator: tA_f5
Certified Operator: A, Certification Number: $ lS
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
9W
Design Current
Design Current
Design Current
Swine Capacity1'op
WetrPoultry Cap c ty ,AI?op.
Cattle Sagacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
aia Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
t a-, 1fit DesignCeirrent
D , .Point#*Caacl
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
gW
INon-Layers
Beef Feeder
Boars
pm
Pullets
Beef Brood Cow
-
Other �r, _�
Turkeys
TurkeyPoints
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 fo ❑ NA ❑ NE
❑ Yes
❑ No
Ee' A
❑ NE
❑ Yes
❑ No
[ja- A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) U Yes U No L&TNA U NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑i<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Vo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: = - Date of Inspection:
Waste Collection & Treatment
Yes
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑
[tom]' o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
e. IAA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�lo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0-1vo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q.Kb
❑ 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
To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
���'
l'_�J o
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
IJ 1"o
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s):
//��
13. Soil Type(s): A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
jE2-wu
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[ 'moo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑.N`6`_
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E],No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections❑ Sludge Survey
QP
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -o'— ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 01?<❑ NE
Page 2 of 3 21412011 Continued

Facili Af umber: jDate of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g2l<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q, ❑ 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 ETo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No ❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes [j3190 ❑ NA ❑ NE
❑ Yes LQ o ❑ NA ❑ NE
[-]Yes g2-5-5 ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes t❑, Ko ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E�-No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ ilo ❑ NA ❑ NE
Comments: rfer to question Explain any YES answers andlerany additional recommendations or an of
�r
Use drawings of faciftyto better explain situations (use additional pages as necessary
mT ments:
i
)
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone: 1 `� 3� — 3
Date: he
24,2011

2/.2 6/ 2 aio XX­
2 M. 31-5
Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
01routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
Date of Visit: Z`Z ID l Arrival Time: I/ � J Departure Time: Z �� County: Sm✓ Region:
Farm Name: ! "a7 !'q .�// L } Owner Email:
Owner Name: L a rr //A Phone:
Mailing Address:
Physical Address:
Ckrjr:sYurJC
Facility Contact: L�YVy �0. I, Title: '�� Phone No:
Onsite Representative: Integrator: —, rM4A✓
Certified Operator: a "r Al, a-trloY Operator Certification Number: �g`f/s-
Back-up Operator:
Location of Farm:
Latitude: = o
Back-up Certification Number:
=" Longitude: = o ='
=
Design Current
Swine Capacity Population
Design Curren# Design
Wet Poultry C•apaeity Population Cattle Capacity
Current
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer
❑ Dairy Calf
Feeder to Finish
1 1990
1%Q 8
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Layers ❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Pullets
❑ Beef Brood Cowl
❑ Boars
❑ Turkeys
❑ Turkey Poults
Other
❑ Other
❑ Other
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
ERNA
❑ NE
[--]Yes
❑ No
®NA
❑ NE
IX NA
❑ NE
❑ Yes
❑ No
[:]Yes
P No
❑ NA
❑ NE
[:]Yes
5MNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection FT /d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes QT�
El NA
El NE
a. If yes, is waste level into the structural freeboard?
,N//o
El Yes LRNo
❑ NA
❑ NE
Structure t Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes O N
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes fo
❑ 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 ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,.,/
9. Does any part of the waste management system other than the waste structures require ❑ Yes Lit No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,��
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes h' No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 2r'N'o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
�o. s. W'
12. Crop type(s) Bcvw. Y
� !a r� ,�wticl/ t�s sZr IV/N AV MVrc Id
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ❑ NE
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 ❑ No ❑ NA ❑ NE
Comments (refer to quesh"on # . Explain any YES answers and/oran recommendations or anyrothercomments
:stuations use addition 1aes as nealcessa Use drawings of facili Ito better explain,.i , ., a_-
Reviewer/Inspector Name .: Phone: 9i0, V33. 336p
weave j S
ReviewerlinspectorSignature:Date: 2"ZS-20/0
12128104 Continued

Facility Number: 02 - Date of Inspection
Required Records & Documents �,,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L7 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D<o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B❑ 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
ET'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0"o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3'9—o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E4No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D—No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9'1�o
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
e<o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
To
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ yes
B 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
l__I No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
[I NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
..
CT No
❑ NA
❑ NE
Additional Comments andlor'Drawlggs.
12a8/04
12a8/04

,,
Type of Visit 'Q Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit g Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: El Arrival Time: 1- a� Departure Time: r s County: Region: FR-O
Farm Name: ��U I�^ C (Ag-L) Owner Email:
Owner Name: J rcr Phone:
Mailing Address: Q41a �_� himn,�
Physical Address: ,�� t
Facility Contact: L,6 [ N Title: _ '�"_ Phone No:�-
Onsite Representative: Integrator: i/f h brow
Certified Operator: gy- Operator Certification Number: gr l41� r
Back-up Operator: GICOV919111 �%- Back-up Certification Number: Q�rO`7
Location of Farm: Latitude: EJ o u Longitude: El °
Design Current
�_g_CurreDsiSwine
Capacity Population
et Poultry apacity opulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dtsy, Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
s❑
Beef Stocker
❑ Gilts
FENLaers
Beef Feeder
❑Baars
s❑
❑ Beef Brood Cowl
s
Other
❑ Turkey Paults
❑ Other
IMI
❑ Other
I�umfser of Structures:
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo ❑ 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 CB:No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes C5JTfo ❑ NA ❑ NE
other than from a discharge?
12128104 Continued

r
Facility Nutnber4aa— 3 Date of Inspection ��TT
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes WNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Stricture 1 Stnucture 2 Structure ? Structure 4
Structure ; Structure f,
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard {in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes lo [-I NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes N 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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes � No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Auulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 15; No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ll;No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) / - CQ 1 r In 11 O
13. Soil type(s) Q Is
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 19No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �KNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',❑ Yes
IRNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
tRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
kNo
❑ 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):
1W
Reviewer/inspector Name Pha4W
Reviewer/inspector Signature: Date:
OWJ
12128104 Continued

Facility Number: g — tf Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JRNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
5ZNo
❑ 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
ERNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
W No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�9 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J?TNo
❑ 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
NfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
I"No
❑ NA
❑ NE
Additional:Commeri#s and/or Drawings.Fe
a008
powe- s praj -pd-A &efck +I,(,e
-7• ! 119G+� [.1/✓V Ir/I'rYlid . ✓S�5lI a -few smalllwe slob sh d�r� r� by ►s���l,
Goad 1 Do0�y -ar/n 4 well- 0,9a464 I'1Pt ad'r,
Page 3 of 3 12128104

i �f�1 f
Facility No. $a� Farm Name No�,t� Date<
Permit-' COC
Pop.Type Design Current
OIC NPDES (Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard-( —in)>
:
Sludge Survey Date
Sludge De th ft & %
Liquid Trt. Zone
S]N r%1
Calibration Date
1
2
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Actual Width
Soil Test Date (S
pH Fields
Lime Needed I
Lime Applied �T011Q —
Cu Zn rrn
Needs P 0
Crop Yield
Wettable Acres T
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections
120 min Inspections t/
Weather Codes
Transfer Sheets #
RAIN GAUGE
Analysis -i +• +i E� . %*� 1• r. �.S�s rat.''
�1r - Nmll-M�
lies
.
!..
. �f■ate
i7lldi��■1:�,1
��
� 1
°= I
i
i
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 1a1C.Q-1 Date last WUP at farm
FRO or Farm Records
Lagoon # Qaa.
Top Dike
Stop Pump
Start Pump qlr%5-
App. Hardware a �P
Oalf)o in DfW(e 710d

ry 00
2:
C>
i� XZ�"

Type of Visit 48LCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
ci0 Departure Time: County. �+ -Region: Date of Visit: � Arrival Time: 1® `�� Re �'0
Farm Name: NdUl Rams 1A4'�.i Owner Email:
Owner Name: T NGIV ��' Phone:
Mailing Address: a 'ah AA C Ih093a
Physical Address:
Facility Contact: Title: Phone fNo:
Onsite Representative: AA '' Integrator:
Certified Operator: Operator Certification Number: Ay✓,4 o y ts-
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 6 = I = u Longitude: 0 0 = I = u
Design , CUrrent��Design Currentx• Design Current
Swine CapacityPopulahon * RWetPoult�ry Capacity Population C•a#tle Capacity Population
❑ Wean to Finish RED
a er ❑Dai Cow
to Feeder Non -Layer ❑Dai Calf
Feeder to Finish 'Q ❑Dai Heifer
t r ❑ Dry Cow
❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder ❑ Non -Dairy
ElFarrow to Finish El La ers
f El Beef Stocker
❑ Gilts ❑Non -La Non -Layers ❑ Beef Feeder
❑ Boars ❑ Pullets ❑ Beef Brood Co
❑ Turkeys -Fl.
Other n
El Turkey Poults �
❑ Other ❑Other'., Number oi'Struc_tures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CR 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
N No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:]Yes
Z No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

• Facility Number:g -a 4T- Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CKNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[3No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
Z No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
t'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
CKNo
❑ 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 off� Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C O
4 a. L P SG t? S. L O*�-_ r 1/ �r1 L
`
13. Soil type(s) llya $ Is-, NOA
t �'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
9No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
RNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
07No
❑ NA ❑ NE
Reviewer/Inspector Name As I Phone: [phone] C733�
Reviewer/Inspector Signature: Date:
D__ , s r t »nxin4
- --a - - -j

Facility Number: a — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'R'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
IS 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
IR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ 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
IN No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ER 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
MINo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CRNo
❑ NA
❑ NE
Additions! Commets and/or Drawings:
as , s1* y ��•,�e -F� ate, r� � I � be rn a►led r"� . Die 6r nay BoI � ,
0 f o� of YVa}>q' Ova II'+
7
A4fri-o7con
as r co reel S'f� s�.� i e--7 t y
�ayeileY,11, N C_ ag301
Cleii ed 0vt necaoob— Pf-b 3W?)
-fhen
ar naf s (a Pt s;lire ,
li � A"(), d 1, e r n a 006, w I l ned a,+� b ore �d y�� , Npwhas a sae rs•
Page 3 of 3 12128104

FacMy No. 3 Farm Name
Permit COC OIC_
Date
NPDES (Rainbreaker
PLAT Annual Cert
Freeboard
Observed (in)
Sludge SurveyDate Perm
--�-�--
Sludge Depth (ftj-----
CI PL,14
alibration Date
Actual Flow
Actual Width
SoinMNg
pH n
Lime Needed
Cu ✓
Zn �Actob�
Wettable Acres ✓ Rainfall >1"
Crop Yield 1 in Inspections -�
Rain Gauge 120 min Inspections
Weekly Freeboard N��' Transfer Sheets Y7 (6_
WUP 16�j-4-0 P�
. � r .
.
fir. R�
• ..
+�
W'DoC& p lZ118-i Ily" 311 -s Ir1
Pull/Field
Soil
Crop
Pan
Window
SG
-
t

Type of Visit 'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (%Roo]utine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: c Arrival Time: Dqparture Time: My County 14 SM Region:
Farm Name: &UhY -Qf5 C R. Owner Email:
Owner Name: V 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: k a 'y r
Onsite Representative: f '
Certified Operator:
Back-up Operator:
Title: 11�)lA 1'leJ( Phone No:
1 Integrator• Prem49� —
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 ' FT
Longitude: = ° 0
Design Current Design Current �DeslgnCurrent
Swine Capacity Populatian Wet Poultry Capty Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑Dai Cow
❑ Wean to Feeder ❑Non -La er ❑ Da' Calf
eeder to Finish
a
`7 ❑ DailyHeifer
:.� , �' `-�, �
Imo,,, ,
Dry Poultry :'. ❑ D Cow
`,I.. *` ` ❑ Non -Dairy
❑ Layers El Beef Stacker
❑ Non -Layers 4
❑ Pullets ❑ Beef Feeder
❑ Turkeys ❑ Beef Brood Co
Other
❑ Other
El Turkey Poults
❑ Other 14beIrStructures: E
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Discharges &Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes *o ❑ NA ❑ NE
❑ Yes ❑ No P NA
12
❑ NE
❑ Yes ❑ No A
❑ NE
❑ Yes ❑ No ANA
❑ NE
❑ Yes ANo ❑ NA
❑ NE
❑ Yes A No ❑ NA
❑ NE
/28/04 Continued

Facilih 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
❑ Yes )iNo ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in). -
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes .�allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes JDNo
❑ 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?
171 171 Yes ❑ No
ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PqNo
❑ 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 J�)No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes "INo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes rot,
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outsideof Area
�T 01� C04ye,
Lka'/l`
�} ,�
12. Crop type(s) l�CA iYl� _Q� r'
zr CCI�M
-- -
13. Soil type(s) 1x--)�__e , LID T
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�?No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination 7❑ Yes T No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes M No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): '
Reviewer/Inspector Name C AA etSTI C &AIQTC&JPhone:(:] O 433 'Z
Reviewer/Inspector Signature: ` Wp Date: L
12128104 Continued

` Facility Number: a,— Date of Inspection
Required Records & Documents
�I
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNO
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo,
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
WNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
j
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
ElYes
1PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
1
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
YNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
121,No
❑ NA
❑ NE
Additional Comments ai iWor Drawings: _
C Q-041cui ¢CV, IJ Cn AL
- ('eSs�c� fcF, ems+5 -lcrn� need 4 Q� a�a Sa�rc.
6A POSs; le i"" u st o /� m w 1 cD►}
Page 3 of 3 12128104

I
Facility No. -C)- Time In n
Faun Name �.
Owner
Time Out Date
Integrator ,12:,
Site Rep
Operator No. � I _
Back-up No.
COC ��� Circle: neral or NPDES
Design
Current
Design
Current
Wean -Feed
Farrow - Feed
Wean -Finish
Farrow - Finish
ed - Finis
Gilts I Boars
Farrow - Wean
Others
FREEBOARD: Design
oiuuyc Sui v6y
Crop Yield
Rain Gauge
Soil Test /
Weekly Freeboard e/
SpraylFreeboard Drop +
Weather Codes
PLAT _�
Daily Rainfall
7 _v 1 <
120 min Inspections
Waste Analysis:
Date Nitrogen (N)
1
Observed
CalibraticnlGPM ✓ ! �C7 _
Waste Transfers
Rain Breaker—r
Wettable Acres
1-in Inspections •�
S1ualpo
Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
{- v
t --

(Type of Visit O'Cmpliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit oRRooutine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: %�� a 0 (0 Arrival Time: c} .Q Departure Time: County: Region:
Farm Name: F _ r �U rn 5 �_� f L Owner Email:
Owner Name: Phone:
Mailing Address: Zq 0 r-kr CST/7'b
Physical Address: J q (P V _ Cjk Ufck" — �}��
Facility Contact: Y K)o4or Title: W � Phone No:
1 i k _ n ;Z, f f
Onsite Representative: 1 '
Certified Operator: j-
Back-up Operator:
Location of Farm:
0 k ufck 1
N 'n: t,3 %
Latitude: = o
U
Integrator: 1— 1 Cd I I I Vt M V`[y K I- X LjYV
Operator Certification Number: 1 v `
Back-up Certification Number: ct� W 33
Longitude: = o = ' = "
Design Current
swine Capacity Population
re
Destgn Current
Wet Poultry- Ca acity Population
Pa
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
eeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
D , Poult
ry"`
❑ D Cow
❑ Farrow to Feeder
-'° "`':"°j
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
—
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
Other
Number o#'Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )rNo ❑ NA ❑ NE
❑ Yes
❑ No
PtNA
❑ NE
❑ Yes
❑ No
[XNA
❑ NE
❑ Yes
❑ No
CRZVA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
►i
Designed Freeboard (in):
' r r,
Observed Freeboard (in): Y'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ) No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /9h No El 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 DPNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA El NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc_) ,
❑ PAN [__1PAN > 10% or 10 ]bs ❑ 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) lu m ud-o, PQ34w (L ,t 11 Cn eo , v3
13. Soil type(s) W ga c a xy,_
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
? ❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes tZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes "P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations.or;any other comments .«
Use drawings of facility to better explain situations. (use additional pages as necessary): a
�
Q Z
Reviewer/inspector Name Q►�S'r) N� �� ` (���� Phone: 1 1(2)� .73.33M
Reviewer/Inspector Signature: 5�,�.. o�bPPZ4 Date: 1 b
Page 2 of 3 121281040 Continued

Facility Number: — Date of Inspection -1 a b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? E:]Yes,*"m No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ' gNo ❑ 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
VkNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Y$ 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
❑ LNo
[:].NA jjrNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;%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
"o
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
j
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Wo
❑ 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
t9'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
)4No
❑ NA
❑ NE
Additional Comments and/or Drawings:
A,
�i,(-C.� . LU
tj
T"JIL
Page 3 of 3 12128104

Facility Number �" 3q Date,l Time rN`? . Q Out
Farm Name, N O LAX 0 y TCw /vi.s ( Iq :V L
0.1.0 U No.
C.O.C. Genera 9 O NPDS
Desti Current Design Current
Wean to Finish Wean to Feeder
er to Fint 1' Farrow to Wean .
Farrow to Feeder Farrow to Finish
Gilts — - - - - Boars
Other
Soil types _
Crop Types lk ALA b►.— Pan Window Ma it
---756
�.� r Nov
Soil Test+r1 '"'Plat N 74
Designed Freeboard served Freeboard
Rain gauge 'Rain breaker _ _ Daily Rainfall Waste Transfers -�
Calibration of spray equipment G.P.M.
Sludge Survey Crop Yield
1 in. Rain inspections
r-eh f %
Pumping time
Waste Analysis % & Month
Comments
Weather code
120 Minute inspections,
Weekly Freeboard
`14- /,� `/I 1

Division of Water Quality
Faeffity,Number O Division of Soil and Water Conservation
I IS O
Other Agency T'
Type of Visit 49 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 ,Z -p Arrival Time: 9' 3d Departure Time: County: Region: F/PO
Farm Name: N-yl-r 6w s - AarL -_ Owner Email:
Owner Name: Lal=,l _ Phone: 9/0- Sd If 8� g
Mailing Address: a2 y 01 [411rcA /Qoa� _ G/%I re . NC 283 2 >�
Physical Address:
Facility Contact: La, N �a Citle:
Onsite Representative: LGr
Certified Operator: L ar
Back-up Operator:
Location of Farm:
Phone No: (�9b' 99r1' `irJ4y
Integrator: —,A—"
Operator Certification Number: 19 Y1 S"
Back-up Certification Number:
Latitude: 0 0 = . Longitude: Ej ° ❑ ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ La cr
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
[Teeder to Finish 11 99 0 lBQo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: RI
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 L3N' o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2-,f o
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
12128104 Continued

r ,
Date of Inspection
Facility Number: — �t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D'NO
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
allo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: _f_.
Spillway?: RO
Designed Freeboard (in):
Observed Freeboard (in): 31-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2%
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ErNo
❑ 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
Mo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
2No
❑ 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
ErNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
�,/
L�J No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
O No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
to� 106
12. Crop type(s)
�,Uer.n �a sl".// e,._s.•11 6'0*dt2 .' 4/,•..1g,- A., ��Rl
13. Soil type(s) f 1,,,6 , IVC24
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ErNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination[:] Yes
EIo ❑ NA 0'KE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA [a NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[110
❑ NA ❑ NE
Re-14A,eel DesFre e4qu,,1 hwe/ &-.'fA m, No, �oP,
Reviewer/Inspector Name '` a t�RPhone: GJ p _ de
Reviewer/Inspector Signature: Date: 3 -V T—
1 L/60/VM uvnunaea

Facility Number: — y Date of Inspection -1-0
Required Records & Documents ,,---,,!!
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 2 o ❑ NA ❑ NE
9
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box. ❑ � []CAfists ❑ g�,n ❑ ]�5s [:]Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DINN o ❑ NA ❑ NE
.2 .7•/ 1.5- 49-20 -.7/.7
❑ ❑ ❑ sdil-"*sis ❑ ❑ Annual Certification
❑ ❑� ❑ ❑ s ❑ W'-R�d.e
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25_ Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/[nspector fail to discuss review inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Blo ❑ NA ❑ NE
❑ Yes
[lgo
❑ NA
0 NE
❑ Yes
E?No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
Q'NE
❑ Yes
9-No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
2-?qE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes 9lo ❑ NA ❑ NE
❑ Yes [2No ❑ NA ❑ N E
❑ Yes
91,io
❑ NA
❑ NE
❑ Yes
Z"No
❑ NA
❑ NE
Additional., Comments and/or Drawings:ys
w.
61
12128104

Type of Visit Q'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: I = 30
Q Not Operational O Below Threshold
Mlr
rmitted 13'Zertified © Conditiion0y Certified 0 Registered Date Last Operated or Above Threshold: ......... ...............
S�-
Farm Name: A�* r r C &t..- A r L County;
Owner Name: 1' `T-•1 ....... Phone No:
�Iarhn Address: -►` !L Pi .- .otg----.......
Facility Contact: --- -v /`k� �� oe Title: 4?�. �vr - — _. » ._. ._ _ . Phone No: _ ...
Onsite Representative: !_� &.g.. -- ... Integrator:
Certified Operator:, lid• Njam Ior Operator Certification Number:._..1 D.
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` 0« Longitude �• �< �«
Discharges & Stream I_mriacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q'�o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)U yes ❑ No
c. 1f discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ} ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes to
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EKO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Structure 2 Structure 3 Structure 4
❑ Yes UR'r4o
Structure S Structure 6
Identifier:
Freeboard (inches):
12112103
Continued

Faci* Number: g.7 — C
Date of Inspection ®0
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 maintenancetimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A PRlication
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ,,vt +1 se"k Ll f (t; o ow S*-ej
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
--
�rj ry"
Reviewerllnspector Name
.j-
ReviewerAkwpector Signature:
❑ Yes &1(0
❑ Yes B'<lo
❑ Yes j " o
❑ Yes <0
❑ Yes �No
❑ Yes 2No
❑ Yes Q(No
❑ Yes dNo
❑ Yes �No
❑ Yes [(No
❑ Yes ffNo
❑ Yes Bf-4o
❑ Yes ER'go
❑ Yes [3Fo
❑ Yes M No
❑ Yes M<o
❑ Yes B1<o
Copy ❑ Final Notes
Date:
11I12103 / / Continued

Fa i 'ty Number: S 9 _ 3K5 I 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/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
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 review/inspection 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?
NPDES 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?
33. 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 NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute inspections ❑ Annual Certification Form
❑ Yes Bfqo
❑ Yes 53NO
❑ Yes G?fqo
❑ Yes GkKo
❑ Yes [RNo
[:]Yes 3 No
❑ Yes [.?'�o
❑ Yes 9<0
❑ Yes [(No
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Site. Requites Imtttedistc Attenii&s
Facility No.
DIVISION OF EWMONMEMAL MANAGEMBN7
ANMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. 10 �% , 1995
Time: 1
Firm Name/Owner:.' U�Mkg Lk- yiA.e Y1S
WIWS Add.==%: 'RI I 7&X � 7$ � � �..�.• l N l �N .L . Z 3�, —
County: SA A%PsoN
Integrator. M)SE 1n % rVi IL0 S Phone: l~Boo-- �gq—Z l la
On Site Representative: LmULy toky Lr-)R—_ �! Phone: Sc — ZZ`I(,
Physical Addressli ocation: (s e I T -ot CMAZ*t -4koaTL) YZ ,n,��t�,aavv, tka.
tv%.A -f k.59-%;V Q) ti M4 / MoB
Type of Operation:
Design Capacity:
Swine
Poultry
Number of Animals on Site: �-IZ--
DEM Certification Number: ACE DEM Certification Number. ACNEWL—
Latitude: • w Longitude: -' 4 -"
Circle Yes or No
Does die Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) es No Actual Freeboard: Tit. O Inches
Was any seepage observed from the l oon(s)? Yes o No as my erosion ab ?Yes No
Is"
land available for spray es No Is the cover crop adequate? Yes No
/"
Crop(s) being utilized: . ��S t }R'Y � -- 3Z �cw2S
Does the facility meet SCS minimurn setback criteria? 200 Feet from DwellingsXXc br No
100 Feet from Wells? es No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes Na
U animal waste discharged into waters SLAbe state by man-made ditch, flushing system, or other
similar mar, -made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate wam management records volumes of manure, land applied,
Way irrigated on specific acreage with cover crop)? Yes os.L�J
Additional Comments:
"M 'V� ot) v 1--�S;
Inspector Name Sipahw
ce- Facility Assessment Unit Use Attachments if Needed.