820384_INSPECTIONS_20171231

NORTH CAROLINA J
Department of Environmental Qual

Type of Visit: O Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; / J Departure Time: ; 3 D County: 5 egion: �
Farm Name:
f/U,'��1
S Wa��s /n't-
Owner Email:
Owner Name:
Gl/, sr
I%7aY cC� P 4r/"in -E
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Scc zP Integrator:
Certified Operator: /4(qll�e J�c�! t CtY� Certification Number: y7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Swine
Capacity Pop.
.� Wet Poultry
,ACurrent-
Capacity,; Pop
€`Cattle
Capacity Pop.
SED
dNil�4i,
f o
x'11N
Wean to Finish
Layer
airyCow
Wean to Feeder
Non -La er
I
I
Dai Calf
Feeder to Finish
/,�
3j'i '
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca acity
vyCPis'�..Ay",
Po ".
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Soars
Pullets
I Beef Brood Cow
�l
°I
Turkeys
Other
�.
Turkey Poults
Olher
p,,
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ErNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 6-No
❑ Yes 120�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Numb jDate of Inspection: —/ /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[2'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
D 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
FTNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ET<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
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0
❑ NA
D. NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [j 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 Approved Area
12. Crop Type(s): rZ l'k-t
13. Soil Type(s): xz'}'-Z S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LT -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3- ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
D<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
El -No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[l]No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z'—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 [r] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0-<0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Y]'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

6IFacility Number: I Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'lqo ❑ 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 to ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ivu ❑ NA ❑ NE
Other Issues ��
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E.,�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 []"No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E] 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
E 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
E jl o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0-15-o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑moo
❑ NA
❑ NE
Reviewer/Inspector Name:
9--/r, — T v3--D 157
Reviewer/Inspector Signatui
Page 3 of 3
Date: // / /,?-�
21412015

Type of Visit: 40Compliance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: O R/outine 0 Complaint 0 Follow-up 0 Referral 0 Emeritency 0 Other 0 Denied Access 11
Date of Visit: I 10-i 9- 11 Arrival Time: .',3 D Departure Time: c7 County- Region:
Farm Name: y ; wi f7lrrr_Dwner Email:
Owner Name: ?,(% , r Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 d7joW r� _ _ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
G , Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
i}esigu
Current
Design Current
Swine
Capacity Pap.
Wet P©uttry
Capacity
Pop.
Cattie .
Capacityp Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
f„
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.nul
Ca aci
PS .
Non -Dairy
Farrow to Finish
It -avers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
k "
Discha es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ELNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ Yes RNo
❑ Yes r17 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ---�=
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo
❑ 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 RNo
❑ 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 CKNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo
❑ 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 'rype(s): &'ryL ! `W X —0/ / S yY�iS>►�—g- S
13. Soil Type(s): rZ.2_ 5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [&No ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes J&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [Rj'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2No [] NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0,No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes kNo [] 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 L&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I
Facility Number: - Date of Inspection: —/ g
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L2�No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [RNo
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 [K No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
JIC�7] No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
E.No
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
ZNo
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�l No
34. Does the facility require a follow-up visit by the same agency?
[] Yes
E�No
Reviewer/Inspector Name:
❑ NA ❑ NE
[INA ❑NE
❑ NA ❑ NE
C] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signatw
Paige 3 of 3
21412015

' . iv'i"sion of Water Resources
Facility Number ®- © Division of Soil and Water Conservation
OtheAgency r
Type of Visit: &Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Routine O Complaint ollow-up O Referral O Emergency O Other O Denied Access
Date of Visit: © Arrival Time: ' /S' --Departure Time: County: Region:
Farm Name: /tea' Owner Email:
Owner Name: GC% _� rJfe,7/�'w-f fcl�""' --r-7A G. Phone:
Mailing Address:
Physical Address:
Facility Contact: ���z-Y�� /17p_�rY Title: «
Onsite Representative: vlt-c , ii7� Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current Design Current
Swine
Capacity _PoppWet Poullimtry
CapactyY l?op Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
121
INon-Layer
Dairy Calf
Feeder to Finish
.;. Dairy Heifer
Farrow to Wean
Design iCurrent D Cow
Farrow to Feeder
D.. - P,oult .
Ca acit ` Po " ;'_ Non -Dairy
Farrow to Finish
�.
_.
La ers
_
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_
Turkeys
Other
Tr key Poults
{
Other
Other`'
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes JE5.No ❑ NA NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Ycs ❑ No ❑ NA ❑ NE
❑ Yes JE�No ❑ NA
❑ Yes MNo ❑ NA
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
'. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
JKNo
❑ 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
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
E[No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
jE],NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_
❑ Yes
❑ No
❑ NA
_&NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window- ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[gNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
� NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
aNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[.NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
J�g_NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
E[NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
}aNE
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 1p NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Sol] Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility tail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ff NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA J&NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Ins ection: / — 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [] No ❑ NA IN NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ONE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
❑ No
❑ NA
Eq:NE
❑ Yes
❑ No
❑ NA
L!�VE
❑ Yes
❑ No
❑ NA
5T NE
❑ Yes ❑ No ❑ NA � N E
❑ Yes ❑ No ❑ NA ONE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No
❑ NA
_5�[ NE
allo
❑ NA
❑ NE
❑No
❑NA
❑NE
E3-No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�k- A'5:�'5 � TIAJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: T)/D 3C7?td/ �
21412015

4
on of Water Resources
Facility Number - 0 Division of Soil anfia-MerIConservation
� Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - fJ-/ Arrival Time: Departure Time: ,' County: Region:
Farm Name: /�r J % « - �� -a 7VXf ry —a o, n -Owner Email:
Owner Name: (iiJ �_�QYti1�r Fa y C, Phone:
Mailing Address:
Physical Address:
Facility Contact: z'= rr,. r Title:
Onsite Representative:
Certified Operator: % p .._.
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
a•
Certification Number:
Certification Number:
Longitude:
�JpjliDesign
Swine
Wean to Finish
Capacity
Current
Pop. Wet Poultry
Layer
Design
Capacity
C►nrrent
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
_
1)r' Pohl o
Design
Ca aci
Current
P.o
Da' Calf
Feeder to Finish
Farrow to Wean
��
Dai Heifer
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Other , .::
'.
r
Turkeys
TurkeyPoults
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 Callo ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes [—]No
❑ Yes [:]No
❑ Yes E No
❑ Yes P!�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: /a /Z_
Waste Collection & Treatment
',,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [a No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes allo ❑ 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 E�gNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo• ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z[ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
Z 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
allo
❑ 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
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[9, 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
ENO
❑ 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
a No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes [3-No ❑ NA [] NE
Page 2 of 3 21412015 Continued

FaciliNumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E2KNo ❑ NA ❑ NE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes [3 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes nNo ❑ 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
RM No
❑ NA
ONE
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
O 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
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2E�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Eg-No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andlor any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7"'e" l3. 7 r__Ueo `!J 0,, //—
40
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature:
Date: // "v
Page 3 of 3 21412015

Type of Visit: Off Compliiance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance j
Reason for Visit: Routine p Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access I
Date of Visit: Arrival Time:7U770­1 Departure Time: L1111 County: Region: 14__%Z
Farm Name: Owner Email:
Owner Name: 141r 'T:�7c , Phone:
Mailing Address:
Physical Address:
Facility Contact: '7 Title: Phone:
Onsite Representative: _5;7G_,� _ Integrator:
Certified Operator: 71�_ �j��-� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
'Design Current Design
apacity Pop. Wet Poultry Capacity
ish La er
Current
Pop.
Cattle Capacity Pop.
DairyCow
rFarr7owto
der
Non -La er
DairyCalf
nish
can
eeder
Design
D , . P,oul Ca aci
Layers
Current
P,o
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Non -Layers
$oars
Pullets
Beef Brood Cow
Othe
Other
Turke s
urkey Poults
Other
DischaLrges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o No [_]NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes [�No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [K No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ®-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
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 C.No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Cro�p� Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): 1717,e 'ti-
13. Soil TyPe(s): i r�,�� ,UD
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes r--" No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
[—]Yes CEYNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ;2-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 WNo
❑ 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 jallo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - 3 Date of Inspection: =
,f 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CS No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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 V�jTlo ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[3.No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
allo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,[No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[LNo
❑ 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
[B 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
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
S No
❑ NA
❑ NE
Use dr�awm s„of;facilr to+beiter:ea lain. situations, use,addrhanal. a esmas nice! recarnmeaiiattons organ other comments.
om g e er toquestion . ExPlainan YES° (swersand/or. apn gaddit,onass �).jg � v...„ rM
P �. Y
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Phone: 0
Date:
21412014
Page 3 of 3

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
820384 Facility Status: Active
Permit: AWS820384
❑ Denied Access
Inppectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit
Routine County:
Sampson Region:
Fayetteville
Date of Visit
11/05/2015 EntryTime: 10:00 am Exit Time: 10:30 am Incident at
Fans Name:
Wiliam S Matthews Farm
Owner Email:
Owner:
W S Matthews Farms Inc
Phone:
910-990-3922
Mailing Address:
235 Billy Matthews Ln
Turkey NC 28393
Physical Address:
235 Billy Matthews Ln
Turkey NC 28393
Facility Status:
❑ Compliant ❑ Not Compliant Integrator:
Murphy -Brown LLC
Location of Farts:
Latitude:
35° 02' Longitude:
78' 09' 47"
From Turkey go north to Moores crossroad, right on SR 1919, turn left on SR 1908 go 1 mile turn left onto private road_
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Kyle Davis Sutton Operator Certification Number. 994947
Secondary OIC(s):
On -Site Representativels): Name Title Phone
24 hour contact name Greer Moore Phone
On -site representative Greer Moore Phone:
Primary Inspector: Steve Guyton Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
records reviewed 2-2-2016
not on inspection Thec Spec. had health issues that delayed records review
page: 1

Permit: AWS820384 Owner - Facility : W S Matthews Farms li Facility Number. 820384
Inspection Date: 11/05/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Feeder to Finish 1,500 1,200
Total Design Capacity: 1,500
Total SSLW: 202,500
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon 1 23.00 30.00
page: 2

Permit: AWS820384
Owner - Facility: W S Matthews Farms 6 Facility Number: 820384
Inspection Date: 11/05/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Dischames & Stream Impacts
vas No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did 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)
❑
01111
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes No Na No
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (i.e./ large
❑0
❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑
❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820384 Owner - Facility : W S Matthews Farms li Facility Number:
820384
Inspection Date: 11/05/15 InppecUon Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes No Na No
Crop Type 1
Corn, Wheat, Soybeans
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Rains
Soil Type 2
Norfolk
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑ 0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ N ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑E ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ E ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑ E ❑
❑
Records and Documents
Yes No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekty Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS820384 Owner - Facility : W S Matthews Farms I4 Facility Number: 820384
Inspection Date: 11/05/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Ye_s No Nit -No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23_ If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑0
❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
E ❑
❑
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?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑
❑
Other Issues
yea
No_N"e
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
M ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ 0 ❑ ❑
CAWMP?
33. Did the ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ 0 ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ M ❑ ❑
page: 5

Type of Visit: 'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: D Departure Time: / + c7 County:
Farm Name: t�LjLy fa 01'1^­ Owner Email:
Owner Name: ���� YI%�' I J 11 �u1 I rArh-%- a7I e_, Phone:
Mailing Address:
Physical Address:
Facility Contact: - Inaf'cr Title:
l►e- . Phone:
Region: 11=�_0
Onsite Representative: "5,Integrator:
Certified Operator: j� i� ,s �, Certification Number: 91-9--
y }Zf 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design CurrentY;
Design
Current
'� r Design Current
Swine
Capacity Pap.
:Wet Pntiltry _' xCapacity
Pop.
Cattle - Capacity Pop.
a
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
ceder to Finish
Dairy Heifer
Farrow to Wean
s ,-E
f` * Design
Current
Dry Cow
Farrow to Feeder
D ;Pool _Ca"act
P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L
I Beef Brood Cow
Turkeys
Other
Turkey Poults
EL Other
v Othcr
Discharges and Stream Im acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
Yes No NA NE
Yes No NA NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) Yes [] No [a NA NE
2. Is there evidence of a past discharge from any part of the operation? Yes [S�No [] NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes [.No NA NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

]Facility Number: - Date of Inspection: O /
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): --- % —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[>_!LNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes W No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CR-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0] 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 Acceptable Crop
❑% Evidence of Wind Drift ❑ Application Outside of Approved Area
Window I
12. Crop Type(s): Gj r,.-,- IINK r l g-�96 r�c��
13. Soil Type(s): wfins l fjCsfFV I&,-
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 CR No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[jjNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ea No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ELNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:11
24, nid the facility fail to calibrate waste application equipment as required by the permit`? ❑ Yes C&No
25. I§ the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®, No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge'? [:]Yes [INo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface rile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes LR No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [3� No ❑ NA ❑ NE
❑ Yes No
❑ Yes [ No
[:]Yes KLNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name: 'z cA-r- ��l��— Phone:
S%
Reviewer/Inspector Signature: P Date: &
Page 3 of 3 21412011

im
Type of Visit: omptiance 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 O Denied Access
Date of Visit: Arrival Time: '. Q Departure Time: ) ', 30 1 County:`Region:
Farm Name: ` a._,,,,t t o jY Owner Email:
Owner Name. Uj -5 f M 4r-r7q r"CL!� F22 orm . Phone:
Mailing Address:
Physical Address:
Facility Contact: (, ,r/ / 71 z-- Title:
Onsite Representative: -:5
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 22 YZI-Z _
Certification Number:
Longitude:
Design Current
Design
@urrent
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
P:op:.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
eeder to Finish
-
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, l;oult .
Ca aci
Pao .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Poults
Other
—Turkey
O ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Q No ❑ NA ❑ NE
[:]Yes [] No ❑ NA ❑ NE
❑ Yes [] No [] NA ❑ NE
❑ Yes ❑ No
[:]Yes CK No
[:]Yes ®No
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Farili Number: -3 eDate of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): —3 �_�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L3�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 S No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�3_No
❑ NA
[D 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): IR '09 i h
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P_No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LgNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
&LNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
.0 No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
21 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 E No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:)Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Faeffity Number: Date of Inspection: — / 9'
24. Did the facility fail to calibrate waste application equipment as required by the permit?] Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List stmcture(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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E4 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [4 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes S No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [3 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 ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes h No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes Z[ No ❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
21412011
Page 3 of 3

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ��Arrival Time: Departure Time: ; p t7 County: Region:D
Farm Name_��,`�f„" j /%%W� /5-API-Owner Email:
Owner Name:__�L 7#4. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: f Phone:
Onsite Representative:
Certified Operator:rju.ir+--
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
DesignCurre
Desigte Current y Design Current
1 -
Swore I� Capacty
!Wet Poultry CapacityPop Cattle Capacity Pop.
_Pop
Wean to Finish
Layer Da Cow
Wean to Feeder
Non -La er Da' Calf
Feeder to Finish
-. F
F' Da Heifer
Farrow to Wean
WDesiloaCurrent D Cow
Farrow to Feeder
D , P.ouli'Po Non -Dairy
A. La ers Beef Stocker
Farrow to Finish
Gilts'
Non -La ers Beef Feeder
Boars
Pullets
Beef Brood Cow
-:=
Turkeys
Others
Turkey Poults
Outer
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[-]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[aNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

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

• FaciliNumher: - Date of Inspection: --/y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C' No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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 E, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M-No [DNA ❑ 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 ® No ❑ NA ❑ NE
[:]Yes EZ No ❑ NA ❑ NE
❑ Yes [!� No ❑ NA ❑ NE
❑ Yes ® No 0 NA ❑ NE
❑ Yes ❑X No
❑ Yes ® No
❑ Yes S No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any,other comments:' Q-
Use drawings of faciliN,46.better;'explain situations (use additional pages: as;.necessary). -
�'*",
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `} j D-4T3
Date: 1
21412011

ivis'ion of Water Quality
Facility Number ®- 0 Di ision of ter
Conservation
©Other Agency
Type of Visit: omphance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: ``-� / / f Arrival Time: UR 3 _07 Departure Time: I al,'O6 Countys g�¢..—
Farm Name: aingr - Owner Email:
Owner Name: —Z:74 e . Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: rI,rr— /Noorr Title: _� SyrG Phone:
Onsite Representative: �iT�c/ ,�?-op. _ Integrator:
Certified Operator: Tnf pog 9, Lns pw Certification Number: Z/ 79�53
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current`;Design
s
Current
Design Current
SRine
Capacity
r
Pop ; " ; ,Wet PoriI ry,�Cagacity
Pap.
Cattle,
Capacity Pop.
Dairy Cow
Wean to Finish [Layer
Wean to Feeder
I INon-Layer I
I
Dairy Calf
eeder to Finish
,5PO
� �- .
ff
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder�DPoultr
Ka� aYJ
Ga acity
P,o
Non -Dairy
Farrow to Finish
Gilts
s " La ers
Y Non -Layer
I
Beef Stocker
Beef Feeder
Boars
-
Pullets
I
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Otherilml
I
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 [g No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
[—]Yes No
[—]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: V= I Date of Inspection: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): gy (V^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? hnL Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [M No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes &a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'E! No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E��Vo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�j/aq,r
Jer
13. Soil Type(s):
—
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes = No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes 0 No ❑ NA ❑ NE
acres determination?
IT 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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes S No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 4 [::]Yes P!�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [,5j,No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA [] NE
Page 2 of 3 21412011 Continued

lFacifity Nu ber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3,No
25. is the facility out of compliance with permit conditions related to sludge? if yes, check [:]Yes 12 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 B No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 Reviewerfinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [S No ❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
[]Yes allo ❑ NA ❑ NE
[:]Yes RNo ❑ NA ❑ NE
❑ Yes
[R No
❑ NA
❑ NE
[]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
PO7se the, )J Ga�4 GS ✓�7pi-; �rn•'ry �i`1/jD vas 1�10-FV,9F76
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �%V y3OO
Date: Z0-I31
21412011

Im
Type of Visit 0<6`mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: LL�L�I Arrival Time: ' O Departure Time: y County: Region: C /• (�
Farm Name: �`c G �!'� Owner Email:
Owner Name: S a� �,� _ T .>^iJ'i �„ �, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:Ll� Phone No:
Onsite Representative: Integrator:_'00/'Vz
Certified Operator: �` m m oY';/i n 4 Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� o = d = is Longitude: [� o = . 0
is
Design Current
Swine Capacity Population
ITTDesign Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish DD
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Pointry
❑ Non -Dairy
rs
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Boars
❑ Beef Feeder
❑ Beef Brood Co
Turkeys
Turkey Points
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
El Yes �No El NA [I NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made? El Yes ❑ No [I NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No El NA El 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 El NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes No El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State [I Yes CKNo El NA ❑ NE
other than from a discharge?
Page 1 of 3
I2/28/04 Continued
Page 1 of 3
I2/28/04 Continued

It
Facility umber: — Date of Inspection (�D�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
n 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
MNo
❑ 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
CO No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? Iaj
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) n frr
13. Soil type(s) ; hAlaen&A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 1Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [&No ❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment? ❑ Yes PINo ❑ NA ❑ NE
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
%IVaDrr_�i�y �i�� Gor�-hrGy
Phone:
r
Date: //—y 2Ffl-10
12128104 Continued

Facility Number: — Date of Inspection 1fl
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps [I Other
21. Does record keeping need improvement? if yes, check the appropriate box below. l2 Yes ❑ No ❑ NA ❑ NE
JR 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
f? No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[>—LNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�fQNo
❑ 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
kNo
❑ 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
C-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
V1 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®.No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O—No
❑ NA
❑ NE
Additional Commeni:s and/or Drawings:
/ I
/You
us f��uJ ���� Ic-91 yyLs �f
Page 3 of 3 12128104

8'L w1 S R• 2�
Type of Visit (9Tompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q11utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r78 'Q Arrival Time: !�: 2S" Departure Time: 2 �+'3` • County: .ScMf'Se'y Region: PWO
Farm Name: _ i �" kAA kri.w1'!� r`}y +^"' Owner Email:
Owner Name b.y-J. d M f-f-h e vas Phone:
Mailing Address:
Physical Address:
Facility Contact: r�'� i� �1.1p d v Title: F s'�C Phone No:
Onsite Representative: �✓ v` Ni: v- e Integrator: N- &-o ` j tv
Certified Operator: ' Saws+-Sov Pi.'t, t3. Operator Certification Number: l 9i13
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o [= . 0 « Longitude: E--I o ET
= "
Design
Swine Capacity
Current
Population Wet Poultry
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer I
Dairy Calf
® Feeder to Finish
i_%O 1
❑ Dairy Heifer
❑ Farrow to Wean
El Farrow to Feeder
Dry Poultry
El Dry Cow
❑ Non
-Dairy
❑ Beef Stocker
❑ Farrow to Finish
[I Layers
❑Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
❑ Gilts
❑ Boars
Other
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
❑ Other
Discharges & Stream Im acts
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 pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes 2No ❑NA ❑NE
❑ Yes
❑ No
B NA
❑ NE
❑ Yes
❑ No
[<A
❑ NE
2 A
❑ NE
❑ Yes
No
El Yes
E❑
03 No
❑ NA
❑ NE
❑ Yes
3No
❑ NA
❑ NE
12128104 Continued

�2 _0,8 0 y
Facility Number: Date of Inspection ji 2 -4 - 07
Waste Collection & Treatment
�/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElG Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes ETNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Z
Observed Freeboard (in): ;z 9
5. Are there any immediate threats to the integrity of any of the structures observed?
--!
❑ E Yes ?I o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes LSNo ❑ 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 D<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes U<o ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE .
❑ Yes 9O
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
❑ NA ❑ NE
❑ NA ❑ NE
12. Crop type(s) Co i -,,j t,_j k "4 � - r4;e_.-LA,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Bo
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
L7No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`:
[] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,Eo
9 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E o
❑ NA
❑ NE
is ,(use.:as�
Reviewer/Inspector Name_. , t / . e(!+` rS Phone: `fi�0• `f3f� 33C�p
�J Reviewer/Inspector Signature Date: 1-22 -198-7-0_02
12128104 Continued

Facility Number: e Z 38 I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UTNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [B o ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3<
❑ 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 El
El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
LE�r
❑ NA -
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
o
El NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,I.R
1 �No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑<oo
ElNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
---,,
i�o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E2N-o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I,�, < El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
i <o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
U—No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
D 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
L_�,'No�❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
L, <0 ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit Q'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ClVoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: '/ County: S�.gSC.�/ Region: /;'10
Farm Name: W t Llia Nn rdilj,, (195W ) Owner Email:
Owner Name: wl, a.,... IVVL 4 ,�J s Phone:
Mailing Address:
Physical Address:
Facility Contact: G 1^C�r c a ✓ Title: ! u�+ �. S Phone No::
Onsite Representative: O' Y Integrator: &1110L.. Rk-INIJ. I
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = n c, Longitude: = ° = I =
14, Design Current
Design Current
DesiMnGuNrent
Cactty-Population
Wet Poultry
Capaety P�opul n,
Cattle Capaulation
inisheeder
red
❑Non -La er
❑Dai Calf
Finish
7
Dai Heifer
w to Wean
Dry Poultry`
_
❑ D Cow
to Feeder
❑ Non -Dairy
to Finish
La ers❑
Beef Stocker
Non -La ersPullets❑
Beef Feeder
❑ Beef Brood Co❑
Turke s
❑ Turke Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
B<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
BIN
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
ElYes
ElG No
!vA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
No
,,
2<
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EN'oo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Lr No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

' /2-cS-or
Facility Number: $Z -3$
Date of Inspection —D9lo
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
El NA
❑ NE
a. If yes, is waste level into the structural freeboard?
Yes
[-II
,�No
_I No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19i
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El"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
CJINo
❑ 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
T Do any of the structures need maintenance or improvement?
❑ Yes
ETI' o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Bl 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 B o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0'go ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑'<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Bl�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0'�lo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[��
NNoo
[I NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El[g Yes
�
o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
giq—o
❑ NA
❑ NE
Reviewer/Inspector Name iL ..:;• '': Phone:
Reviewer/Inspector Signature: Date: /Z—O 2,0,0 19
Page 2 of 3 11/18/04 Continued

Facility Number: 2 - Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B'�Do ❑ 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 appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0-7q'o-
❑ 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 Inspectionss Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
/❑
0
El NA
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
,L�I<K
L�
[:1 NA
NE
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N�o ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,E
LSNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
[3'No
[INA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,--,
I�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2 o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑'lqo
❑ 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
❑'1 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑'<o-
❑ 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
D-i o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EIP-W-
❑ NA
❑ NE
Page 3 of 3 12128104

I
f Division of Water Quality
Facility Number Ul Division of Soil and Water Conservation ll
0 Other Agency
Type of Visit 14SCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit )jRoutine O complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I`ll J
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: LJ Departure Time: i L.C4_30 Cou
Owner Email:
Phone:
Region �
Physical Address: �— I
Facility Contact ���X ` Title: _ t ' C_J2 C - Phone No: ,3&s k�
14
Onsite Representative: �� integrator: �
Certified Operator:. J Operator Certification Number -
Back -up Operator:
Location of Farm:
I1;
Swine
Back-up Certification Number:
Latitude: = a =1 = Longitude: = o =1' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
$`b ❑Nan -La et
❑ Wean to Finish
❑ Wean to Feeder
eder to Finish
fmm_
I-WpM I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifei
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes rkNo ❑ NA ❑ NE
❑ Yes
❑ No
�JNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
-�
❑ No ANA
❑ NE
❑ Yes
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

- Facility Number — Date of Inspection l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes QV ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes W No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t
Spillway?:
Desigmed Freeboard (in): — Ig
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1$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 T�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
T Do any of the structures need maintenance or improvement?
❑ Yes
t No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L� 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
RNo
❑ NA
❑ NE
maintenance or improvement?
/`-'
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Rj No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �q'� —u-Mf
13. Soil type
N�-�a tks) ,�S �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fM No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
1P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9No
❑ 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):
ReviewerfInspector Name C wr Phone: Q
Reviewer/Inspector Signature: Date. �T ZX 17
12129104 Continued

w
Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ko ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ 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
�KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'r;?(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
`Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
INA
[INE
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
0No
❑ 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
P1 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
q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
K�C,"
Ccn, tnl�� ` t> i4� on 14"—` " a I
12128104

1Div"ion of Water Quality �
Facility Number $ �� O Division of SotF and are Conservation
� Qther Agency
Type of Visit `Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: tC ZI Arrival Time: Departure Time: p2 County: Region: Pi�
Farm Name: F ✓ Owner Email:
Owner Name: V I�*� } Phone.-
Mailing Address: -J l Qu15 —Tor or l�
env.
Physical Address:
Facility Contact:DO-VIA I t 046.k) a Title: Lj,)nzr
r� Phone No:
Onsite Representative: _bum_�k &kY — �parm m Integrator:
Certified Operato; US— &kw Operator Certification Number: 8'13
Back-up Operator:
Location of Farm:
ilt�)b}�
Swine
❑ Wean to Finish
❑ Wean to Feeder
04Teederto Finish
%560
I lt&77
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [= o =' = Longitude: [� o [�' = y
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
i
❑ Non -La ei _ _)
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design - Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ DaiEX Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
Eli
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 3No ❑ NA ❑ NE
❑ Yes
IWNo
❑ NA
❑ NE
❑ Yes ANo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�qNo
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�+No
El NA
❑ NE
12128104 Continued

Facility Number: a-3�
Date of Inspection II P/o1i/U{ol
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 i Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: Designed Freeboard (in) :,g Y
Observed Freeboard (in): —• !%
rr
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes *No ❑ NA ❑ NE
❑ Yes 3RNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes )[No ❑ NA ❑ NE
❑ Yes *o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9,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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gNo ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvidenceofWind Drift El Application Outside of Area
12. Crop type(s) Co Y] , bjkle!/. �—O(.1 h�0.�tS (dcll Uv) -
N J
13. Sail type(s) Q� n5 - & IL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
S&
❑ NA
❑ NE
I& Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
NNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Aq No
❑ NA
❑ NE
Comments {refer i4 question #): Expiain any YES answers and/or any recommendations or any other comments.
Use tirawings of facility to better explain situations. (use additional pages as necessary,):
Reviewer/Inspector Name / � ,)Phone: 10 ` 3-33 a
Reviewer/Inspector Signature: Date: Z/
12128104 Continued

Facility Number: Z — 7j4 Date of Inspection GCS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 11No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
AWo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J�No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
NNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'No
El NA
El 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
1ANo
❑ 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
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
$No
❑ NA
❑ NE
,L
Additional Comments and/or,Dravifngs: '
V4
12128104

Mr "�l
Type of Visit a Compliance 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
Date of Visit: Arrival Time: : sw Departure Time: County: 5� S o.� Region: r�
Farm Name: nn. s% '� - Owner Email:
Owner Name: /mac.✓ __ jYl� , E.._s Phone:'7 l o
Mailing Address: 9 a i �auoQw �w ._—..,,,_... ,...— �uakr=y. • /�L' __ •z�1,?
Physical Address:
Facility Contact: Title:
Onsite Representative: --++X -1-ws
Certified Operator: /��. Q �•�c*s o�+
Back-up Operator:
Location of Farm:
Phone No:
Integrator: 4,_ a
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = ' ❑ 4 Longitude: 0 ° ❑ ' ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish /Sou
❑ Farrow to Wean j
❑ Farrow to Feeder
❑ Farrow to Finish '
❑ Gilts j
❑ Boars
Other
❑ Other
❑ Layer
i
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
i
❑ Turkey Poults
❑ Other
Discharges & 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?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:' ❑
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility Number: g1 — 38`F Date of Inspection » ��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfalt) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in): 02'�
Observed Freeboard (in): 3a 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;M No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
14 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M 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
W No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El
No
❑ NA ❑ NE
maintenance/improvement?
IL . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ifasgo
13. Soil type(s) - 11C' NO 4 - ,
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
N No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[19 No
❑ NA ❑ NE
Comme�tts(refertotqueshoo:#) Explain:any YrESjanswers and/oraany recommendataons or any other comments.
�. N.
Use drayvrng5afpfacil�tyto better eiplatn setuahons;(use addatxOnal�pages as necessary)4
Reviewer/Inspector Name E �,e� b Phone:
Reviewer/Inspector Signature: Date: _Z as
l2/2&04 Continued

Facility Number: 9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VP No ❑ NA ❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑. Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
CE No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
[id NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
[__1 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
55 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
V] 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
G4 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
[9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
12128104

Type of Visit aTompliance 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- S 6 Time:
� $
O Not Operational O Below Threshold
© Permitted © Certified 0 Conditionally Certified 0 Registered
�Date Last Operated or Above Threshold: --- -
Farm Name: ..... ...... ..................� :........L_'. ,kVS ..._..cS` ► G...... County:
Owner Name: fry,
l ...__ �_ Q ___ _ Phone No.
:Yladmg Address: Y_ r .__ .. ..... !" � f� � - — ... _ - �r�w .... � . _____ �� .. .Q"_'.! S /
FacilitvContact: .. _._..:.�`�"�_..Title:........�lL��'�"�.............�...._.. --._.. Phone No:
Onsite Representative T
In tor: „
Certified Operator:- ....---............ -_-- _ _ _- Operator Certification Number:-------..
Location of Farm: A.��
a
er_
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Quo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [:)No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes &�K40
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes W40
Waste Collection & Treatment ���
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway El Yes Gl? o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............1.......... .... _--------------.•-..
Freeboard (inches):
12/I2103 Continued

Facility Number: ig —v4l Date of Inspection
r
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [�io
seepage, etc.)
6. Are there strictures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes W-Ko
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes 031TO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes M-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes GWo
elevation markings?
Waste Application
10_ Are there any buffers that need maintenance/unprovement? ❑ Yes 21qo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2<0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crop type &- Lon s
13. Do the receiving crops differ with thost designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [Ko
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 5R1q0
b) Does the facility need a wettable acre determination? ❑ Yes G?Ko
c) This facility is pended for a wettable acre determination? ❑ Yes &Kio
15. Does the receiving crop need improvement? ❑ Yes Rrio
16. Is there a lack of adequate waste application equipment? ❑ Yes & o
Odor Issues 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes BAO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [SNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j�No
roads, building structure, and/or public properly)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes UR44o
Air Quality representative immediately.
Caxnments _(refe to qQn #) Exi�larn a Y YES aaswexs aV_vr anyat,vas'o y other comiamts. F
Jx>` wiags ly exPlam� (ose:addrhanai es asaecxssa ) = �•u c.
JJUdra of fact tu-Better _ _
_ _ _ _ � �, .. _ � . _ _ _ - �_���,-..� __ �.� _ . �_ _... ,.. _ . ry. � 'i Q'Field COPY ❑Final Notes �
/10 &d" AU18.
Reviewer/Inspector Name
Reviewedlnspector Signature: Date: Z. G
12112103 lY Continued

Faces ty Number: _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[?<o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
M 40
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
pFlo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
aPie
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
[�lo
(ie/ discharge, freeboard problems, over application)
❑
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
mggo
28. Does facility require a follow-up visit by same agency?
❑ Yes
�To
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Glfo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
��
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Forth
12112103